Congress left for holiday break with no resolution to a lingering healthcare tangle.
Without any congressional action, about 22 million Americans who receive the enhanced Affordable Care Act subsidies to lower the cost of their insurance premiums will experience a spike.
The subsidies expire Dec. 31. The open enrollment period already began Nov. 1.
West Virginia is expected to be hit hard, possibly seeing some of the largest rate increases in the country. About 50,000 to 60,000 West Virginians would see higher prices without an extension of subsidies.
The average consumer is likely to see out-of-pocket payments more than double, according to a recent analysis from KFF, a health research group. Many of those include self-employed business owners, freelancers and early retirees.
“Well, this is an issue. It’s an issue for 60,000 West Virginians,” Senator Shelley Moore Capito, R-W.Va., said during a briefing last week with West Virginia reporters. “Most of the people that are falling into this enhanced premium bucket are small businesses — are people that are working, that are trying to do the right thing.
“And I’ve gotten numerous — and I’ve read them all — communications for people where they might have been paying 200 and now they have to pay 1,400 or, I mean, just astronomical increases. And this is a concern.”
This past week, the Republican majority in the House of Representatives House passed a conservative health care bill that would not address expiring Affordable Care Act tax credits. That bill is not anticipated to be able to survive the Senate’s 60-vote filibuster threshold.
Meanwhile, four members of the House Republican majority joined Democrats on a discharge motion for a bill extending the subsidies for three years. With Congress now out on holiday, the measure won’t come up for a vote until January.
“It’s not a serious proposal by the Democrats, but what it will do is allow a vehicle by which the Senate can come back with a bipartisan compromise,” one of the four Republicans, Mike Lawler of New York, told Punchbowl News.
If that bill passes the House, then it would go to the Senate, where there could be further changes.
Capito, in response to a question by reporter Steven Allen Adams of the Ogden Newspapers, alluded to the possibility of another look at the subsidies early next year. At that point, it would be a retroactive fix.
“So this is important to me. It’s important to many people. I know people are paying right now or because we we’ve let the date slip, but I do think it will be very topical when we come back in January,” she said.
Capito has favored proposals that embrace health savings accounts.
“So I think that part of that plan will probably be part of a bipartisan plan that seems to be coming together,” Capito said.
“There’s a lot of hard work on this, both in the House and the Senate — but in the Senate, I can tell you, there’s a group of about 20 that’s been reported, and I know it’s accurate, that have been working hard to be able to figure out how to transition out of Obamacare into programs that actually work and hold the cost down.”
Tom Susman, former director of West Virginia’s Public Employee Insurance Agency and a longtime healthcare lobbyist, says Congress needs to work on real fixes for healthcare.
“I think what they need to do is do a one year extension of the enhanced tax credits. There’s no way they can pass and implement by January 1 a new program,” Susman, now the operator of WMOV Radio told MetroNews Midday.
“The federal government, you know, they can’t buy a pencil in two weeks much less redo the healthcare system and implement it by January 1.”
The financial pressures are about to become reality for many people, Susman said.
“Imagine if you’re a family of four, you have your own small business, you were able to do your own business instead of working for a large company because of the exchange. Now, these rates have gone from, you know, maybe $10,000 $15,000 a year to $30,000 a year. You’re looking at Christmas. You can’t afford health care,” he said.
“I mean, I don’t think that the folks in D.C. understand it.”
Because Congress has not acted in a timely manner, tens of thousands of West Virginians will face continued uncertainty over the holidays and well into the new year, said Kelly Allen, executive director of the West Virginia Center on Budget & Policy think tank.
“Some have already decided to go without health coverage that will cost double, triple, or more next year with the expiration of enhanced subsidies, while others have made painful tradeoffs like cutting back on groceries, Christmas gifts, and other households needs,” Allen said.
“While there is still time to extend these vital subsidies for West Virginia, small business owners and workers in the new year, it must be a clean extension of the subsidies and include more time for people to enroll in coverage in 2026.”