Earlier today, the Senate rejected legislation to extend the expiring Affordable Care Act (ACA) tax subsidies for three years. Despite Republican Senators Susan Collins (ME), Josh Hawley (MO), Lisa Murkowski (AK), and Dan Sullivan (AK) joining Democrats in support of the measure, it failed 51-48, well short of the 60-vote procedural threshold.
Senators also blocked a GOP-backed health care bill that sought to expand health savings accounts rather than extend the tax credit enhancements.
Senators also blocked a GOP-backed health care bill that sought to expand health savings accounts rather than extend the tax credit enhancements. That bill also included a set of harmful Medicaid policies that were struck from the reconciliation bill (H.R. 1) earlier this year due to budget rules. Sen. Rand Paul (KY) was the only Republican who opposed the plan, citing concerns it “did not go far enough in undoing the ACA.”
These outcomes were all but certain, as neither bill was expected to pass. Rather, today’s votes were largely for messaging purposes, part of the deal Senators struck to end last month’s government shutdown.
Absent a bipartisan solution next week, before lawmakers leave Washington for the holidays, the enhanced credits will expire on January 1 and millions of people will see their health care costs rise dramatically. How such an agreement might come together is unclear, as similar divides exist in the House.
What’s at Stake
The enhanced credits ease ACA Marketplace plan affordability for more than 22 million people, including many older adults who are not yet Medicare-eligible. The credits reduce enrollee premium payments by $705 a year, on average. This assistance has allowed millions of adults ages 50 to 64 buy coverage—spurring a 50% reduction in the uninsured rate among this cohort.
Allowing the enhanced credits to lapse would undermine this progress. Nearly all (92%) of the 5.2 million adults ages 50 to 64 with Marketplace coverage would experience significantly higher costs next year. Premiums could rise by 75% on average, while people in rural areas could see a 90% increase. Older marketplace enrollees are already at a cost disadvantage: under the ACA, insurers can charge people in their 50s and 60s higher premiums than they charge younger adults who purchase the same plan in the same area.
The resulting coverage losses would mean reduced access to care and worse individual health outcomes as well as higher Medicare costs.
While some may be able to find other insurance, millions will not. The resulting coverage losses would mean reduced access to care and worse individual health outcomes as well as higher Medicare costs, because more people would enter the program in poorer health and needing more expensive interventions than they would have otherwise. Across all age groups, over 4 million people are expected to become uninsured unless Congress acts.
Congress Must Act Now
Medicare Rights urges lawmakers to extend the enhanced credits without delay, as well as allow people more time to enroll and make coverage changes. This is a commonsense and urgently needed solution—the health and economic security of millions of Americans is hanging in the balance.
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