Enhanced ACA tax credits are set to expire December 31.Caroline Brehman/CQ-Roll Call/Getty
On Thursday, in a 51–48 vote, the Senate rejected a Democratic plan to extend Affordable Care Act enhanced tax credits, as well as a Republican alternative that boosted a health savings account model. It is now all but certain that the credits, which began under the Biden administration, will expire at the end of the year.
As I previously reported, that expiration will lead, for millions of Americans, to the greatest single rise in health care premiums ever.
In a video recorded after the votes, Sen. Elizabeth Warren (D-Mass.) expressed her anger towards Republican colleagues.
“They voted to increase health care costs across the board, and now millions of Americans are left with the impossible decision of choosing between paying for health insurance or paying their rent,” Warren said. “They’ve all fallen in line behind Donald Trump and left American families in the dirt.”
On New Year’s Day, the Urban Institute estimates, at least four million ACA marketplace users will become uninsured. People seeking ACA insurance will have until Monday to select a plan in order to be covered on January 1.
Some of those people may now choose plans that are less comprehensive because it’s what they can afford, said University of Pittsburgh assistant professor Miranda Yaver, who focuses on health policy. That would leave an even greater number of Americans underinsured.
“The average American cannot accommodate an unexpected $1,000 emergency medical expense,” Yaver said. “It is not exactly hard to run up a thousand-dollar tab in the American health care system, and having a good health insurance plan can insulate us from that cost.”
American Public Health Association executive director Georges C. Benjamin said in a press release that Congress had failed its duty to safeguard the health of Americans.
“Rather than addressing a serious issue that has been on our radar for years, Congress, earlier this year, rejected the opportunity to extend the enhanced tax credits,” Benjamin said, “and instead passed legislation to gut the Medicaid program and make additional changes to the ACA that will result in 16 million Americans losing their health coverage.”
“We’re probably going to see more and more people forgoing coverage and care, which is only going to exacerbate existing health conditions,” said Marilyn Cabrera, the nonprofit Young Invincibles‘ health care policy and advocacy manager.
Yaver is also skeptical of the health savings account model being pushed by Republicans as an alternative. They are not practical, she says, for the low and middle-income people that the Affordable Care Act is supposed to help.
“You have to have the means to put a lot of money into your health savings account, and if you’re barely scraping by and living paycheck to paycheck, it’s just not going to happen,” Yaver said.
Among some people whose health insurance is now in jeopardy, there is anger at Congress on both sides of the aisle. Some Democrats, Yaver said, are willing to “sort of allow a certain amount of harm in the next plan year, not wanting to bail Republicans out from their unwillingness to extend the marketplace subsidies,” ahead of elections.
And for Republican politicians, Yaver said, “there is a real lack of connection to everyday Americans’ struggles with accessing health care, which is not a luxury item. It is basic survival for a lot of people.”
