House and Senate Democrats are pushing leadership to quickly pass legislation to permanently expand subsidies on the health care exchanges — ideally by the end of the year.
Forty-one Senate Democrats, led by New Hampshire Sen. Jeanne Shaheen, and 154 House Democrats, led by Lauren Underwood of Illinois, sent a letter to leadership Wednesday morning urging their respective chambers to move “as soon as possible.”
Enhancements to the premium subsidies enacted under the 2010 health care law expire at the end of 2025. Congress last renewed the expanded subsidies as part of President Joe Biden’s 2022 reconciliation package. Those subsidies aim to help low-income individuals who don’t qualify for Medicaid in states that did not expand Medicaid to qualify for less expensive health insurance.
Since then, a record 21.4 million Americans have signed up for health coverage on the exchanges this year, the majority of whom qualify for subsidies. If the expanded tax credits end in 2025, as many as 3 million Americans could become uninsured and 20 million Americans could see premium increases, according to the Democrats.
“It is clear that the enhanced [tax credits] have proven to be an overwhelming success, and, as millions of Americans face an increase in their insurance costs, it is time to make the investment permanent,” the Democrats wrote.
They wrote that older enrollees and people above 400 percent of the federal poverty level would be hardest hit by the enhanced premium tax credits expiring, and the expiration could hurt health care outcomes in rural areas.
The lawmakers’ push comes on the heels of a new industry coalition that is making a similar push.
On Sept. 12, a new, broad-based coalition of health care groups called Keep Americans Covered announced they were launching to provide a unified voice from the health care industry to convince Congress to expand the premium subsidies. The group ranges from advocates like Families USA to insurance lobbies like AHIP to hospital groups like the Federation of American Hospitals.
Shaheen’s office is working with other Democrats on a new bill to permanently expand tax credits that will be modeled off the New Hampshire senator’s 2023 legislation. But the timing of the bill’s introduction is still unclear, according to her staff.
Partisan issue
While Democrats and health care groups largely support expanding premium subsidies beyond 2025, Republicans have painted the expansion as a waste of taxpayer money and a giveaway to insurance companies.
It also carries a hefty price tag — it would increase the budget deficit by $335 billion over the next 10 years, according to the Congressional Budget Office.
Many Republicans have also cited research from the conservative Paragon Health Institute claiming people lie about their incomes in order to qualify for subsidies.
“By doubling down on the costly and inflationary enhanced premium tax credits, the IRA [Inflation Reduction Act] uses hard-working taxpayer’s funds to camouflage the ongoing flaws with the individual health insurance market,” said Senate Finance Committee ranking Republican Sen. Michael D. Crapo, of Idaho, during a Finance Committee hearing Tuesday focused on the reconciliation law’s health care provisions.
But Democrats see trouble down the line unless Congress acts soon.
“Congress has to protect families from a giant premium spike that’s coming next year when the middle-class tax credits for health care expire,” Committee Chair Ron Wyden, D-Ore. said.
Over the last four years, Republicans have largely abandoned their efforts to repeal and replace the 2010 health care law, but the fight over subsidies emphasizes that they are loath to expand it further.
During last week’s presidential debate, GOP presidential nominee Donald Trump told voters he had “a concept of a plan” to replace the law, and his running mate, Sen. JD Vance, R-Ohio, said his plan would promote choice by putting some people in high-risk pools.
Democratic presidential nominee Kamala Harris is seizing on this messaging, holding a series of health care-focused events in battleground states this week.
Jessie Hellmann contributed to this report.
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