Washington, Oct 23 (AP) - The recent government shutdown has rekindled a crucial debate over health coverage under the Affordable Care Act (ACA), a pivotal issue for both political parties over the past 15 years. Tax credits for those acquiring health insurance through the ACA's marketplaces, also known as Obamacare, are set to expire at the year's end.
Democrats have taken a firm stand, refusing to vote for reopening the government until Republicans agree to negotiate extending the expanded subsidies. Republicans, in turn, are demanding that Democrats first support a motion to reopen the government. While behind-the-scenes negotiations continue, the possibility of reaching a compromise remains uncertain.
A recent poll by The Associated Press-NORC Center for Public Affairs Research reveals that about 60% of Americans are "extremely" or "very" concerned about potential health cost hikes in the coming year. These concerns span across all age groups and affect both insured and uninsured individuals.
In 2010, the ACA was introduced to reduce the uninsured population and make health coverage more affordable for those without private insurance. During the COVID-19 pandemic in 2021, Democrats, having control of Congress and the White House, expanded the premium assistance already included in the law. This amendment eliminated premiums for low-income enrollees, ensured higher earners paid no more than 8.5% of their income, and widened eligibility for middle-class earners.
The enhanced subsidies led to unprecedented insurance enrollments, driving the uninsured rate to an all-time low. This year, the number of individuals signing up for ACA coverage reached 24 million, largely due to subsidies making plans more affordable. If the tax credits aren't renewed, next year's out-of-pocket premiums are estimated to increase by 114%, averaging an additional $1,016, according to a KFF analysis.
With the credits set to expire on January 1 and Republicans now holding full control, Democrats, lacking power but sensing a strategic opportunity, initiated a government shutdown over the matter when funding lapsed on October 1. They insist on a commitment from Republicans regarding subsidy extensions before supporting any government reopening bill.
Democrats introduced a bill in September to permanently extend these premium tax credits but have indicated openness to a shorter extension. "We need a serious negotiation," emphasized Senate Democratic leader Chuck Schumer.
The Democratic stance has reignited Republican opposition to the ACA, which they have campaigned against for years and failed to repeal in 2017. Some Republicans, such as Florida's Sen. Rick Scott, argue that the overarching issue isn't the expiring subsidies, but rather "the cost of health care."
During a virtual briefing, the libertarian Cato Institute and conservative Paragon Health Institute criticized the subsidies as “COVID credits” linked to fraud. Conversely, Senate Majority Leader John Thune expressed willingness to extend the subsidies with revisions, such as reducing income limits and halting auto-enrollment.
House Republicans are contemplating their own ACA reform plans, including phasing out new enrollees' subsidies, and are discussing whether to merge health care reforms with future government funding legislation.
Finding a compromise remains challenging, though some Republicans advocate for extending the subsidies. Sen. Josh Hawley notes that many ACA users "don't really have another option, and it's already really, really expensive." Bipartisan discussions have broached various reform ideas, including implementing income limits and transitioning lower-income individuals to very low premiums to ensure awareness of their coverage.
Despite public stalemate and limited engagement from President Donald Trump, pressure is mounting on lawmakers to resolve the issue before the November 1 open enrollment period. Democratic Sen. Jeanne Shaheen has been proactive in seeking compromise, suggesting Congress could also extend ACA enrollment dates. "These costs are going to affect all of us, and it's going to affect our health care system," she warned. (AP) SKS SKS
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