What Is On GOP Menu For Subsidies?
A good article in The Hill on Thanksgiving breaking down the GOP dilemma on what to do with the Exchange enhanced subsidy expiration that is looming. The issue pits moderate Republicans against conservative ones. There are competing proposals across the House and Senate.
The dilemma: Extend the subsidies and endorse Obamacare or let the subsidies expire and deal with the electoral fallout in 2026. This could be major in dozens of moderate Republican swing districts in the House and several seats in the Senate.
Here are some bills percolating on the Republican side:
Moderates in both parties in House:
One bill would extend the enhanced subsidies for two years but make some changes to assuage conservatives. Those earning less than $200,000 per year for a family of four would keep their subsidies and those earning between $200,000 and $300,000 for a family of four would face a phaseout. Fraud measures would be adopted as well. The bill would extend open enrollment to May 15 given the mass confusion over what subsidies will or will not be and the sticker shock of published premiums.
Another bipartisan group in the House back a two-year subsidy extension with an income cap. It is partially paid for by cutting Medicare Advantage overpayments.
Another moderate bill backs a one-year extension.
Senate HELP Chair Bill Cassidy, R-LA:
The plan from Cassidy would let the enhanced subsidies expire. Congress would then deposit money directly into health savings accounts (HSAs) for people who buy high-deductible plans on the Exchanges. The original subsidies would still go toward marketplace premiums. His idea takes advantage of a change made in the One Big Beautiful Bill Act (OBBBA), which allowed Bronze plans to be eligible for HSAs. Bronze plans feature lower premiums but high deductibles and only 60 percent coverage for medical expenses. HSAs can’t be used to pay for monthly premiums under current law. Republicans like the HSA idea, but there are many critics of and problems with the proposal. They argue it does not provide affordable access.
Sen Rick Scott, R-FL:
Scott’s legislation centers on HSAs and would let the enhanced subsidies expire. Scott’s bill lets states submit a waiver to the federal government to replace the base Exchange premium tax credits and instead fund “HSA-style Trump Health Freedom Accounts.” Unlike traditional HSAs, people could use the funds to pay for both premiums and health expenses. In addition, states could waive certain provisions of the Affordable Care Act, including mandated benefits, among other things. The HSAs could be used for any type of health insurance plan, including short-term plans. Again, Republicans like the individual purchase idea, but the proposal could undermine the stability further in the Exchanges by increasing risk in the program as healthier people leave. It would impact sicker people receiving coverage.
The Trump non-plan:
The president was said to be on the verge of offering a plan that would temporarily extend the enhanced subsidies, potentially for two years, while incorporating income caps, minimum premiums, and fraud protections. The plan also would have HSA contributions and other incentives for enrollees to choose a high-deductible plan.
Trump appears to have backed off presenting something due to opposition from hardline conservatives in Congress.
Let’s hope for a responsible compromise to help Americans with healthcare this holiday season. It is not their fault that things have become so unaffordable.
Happy Thanksgiving!
#exchanges #healthcare #coverage
https://thehill.com/policy/healthcare/5624197-aca-subsidies-republican-options
— Marc S. Ryan
