Political friction is increasing over the imminent expiration of Affordable Care Act subsidies, tax credits that are critical for maintaining affordable health insurance coverage for millions, including about 50,000 to 60,000 West Virginians.
West Virginia is expected to be hit hard, possibly seeing some of the largest rate increases in the country if the enhanced credits are not renewed.
“Something needs to be done here. People are going to be asked to pay thousands of dollars more,” said Brendan Buck, a spokesman for the Keep Americans Covered coalition that includes patient groups, hospitals, doctors and nurses trying to keep the tax-credit rules in place.
The subsidies are scheduled to expire on Dec. 31. The issue is also a key part of demands by congressional Democrats as the federal government moves toward an increasingly likely shutdown next week.
The urgency is heightened by the upcoming open enrollment period that starts on Nov. 1. If Congress does not act before that date people logging on for open enrollment will be faced with significantly higher costs, affecting more than 20 million Americans enrolled in marketplace plans.
“At the end of this year, the subsidies that have made it affordable to buy coverage on the marketplace expires,” Buck said on MetroNews Talkline.
“And that may seem like an end of the year thing, but the reason why it’s so important right now is that open enrollment, when people can go online and shop and buy the coverage for their family, starts on November 1, and if Congress doesn’t do something to extend these tax credits that are about to expire, premiums are going to go way up.”
The Affordable Care Act dates back more than a decade now. In 2021, Congress passed enhanced tax credits, making it more affordable to buy coverage.
Since the increase, the ACA marketplace saw a significant surge in enrollment. Enrollment was 10 million to 11 million people four years ago, and now it is more than 24 million.
“It became extremely affordable for people. They’ve been extremely happy,” said Jeremy Smith, an Affordable Care Act navigator for First Choice Health Systems, who spoke about the situation with WMOV Radio.
Many of the people taking advantage of the ACA subsidies include “a lot of small business owners; it’s also a lot of people who work for small employers — that their employer is too small and they can’t offer group insurance.
“And a lot of early retirees, folks that have worked some pretty manual labor jobs their whole lives, and maybe they’ve retired before the age of 65 and this is the insurance they’re depending on. And then, also a lot of younger folks in their 20s that maybe just have lost their parents insurance and still need good coverage.”
The legislation that prompted the enhanced subsidies came with an expiration date, and it’s about to hit.
Any cost increase that people would experience depends on income, Smith said, but “it’s really going to be some extreme sticker shock for some families out there.”
The issue is currently intertwined with the continuing resolution that Congress is considering to keep the government open as the fiscal year turns over next week.
In exchange for support for the continuing resolution, a key demand by Democratic leaders is an extension of the subsidies first expanded by President Joe Biden and Congress in 2021.
The cost of permanently extending the enhanced subsidies is estimated by the Congressional Budget Office to be about $350 billion over a decade.
Senator Shelley Moore Capito, speaking in a briefing with West Virginia reporters last week, described her concern about the expiring benefit. The senator noted that about 60,000 West Virginians have coverage through the exchange and benefit from premium subsidies.
“So it’s a sizable amount of West Virginians, so I’m concerned about it,” she said.
But Capito said she does not support including the extension in the continuing resolution because of the overall cost.
Capito, R-W.Va., suggested that the decision on premium support could come later this year. Capito said she’d recently spoken with President Trump and Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services.
“We’re making sure that we do it the right way, that we keep the coverage for the folks who need it the most, and that any kind of waste or fraud that’s in these programs is is eliminated at the same time,” Capito said.
“So I think we should take our time with it. It is does expire at the end of the year, so we have a little bit of time. We certainly are going to be relooking at the continuing resolution in November, and I think that will probably when we when we decide what we’re going to do about the premium support.”