The House passed a Republican healthcare package on Wednesday that didn’t extend enhanced subsidies for Affordable Care Act plans, signaling the more generous financial assistance will expire at the end of the year.
The bill, which passed 216-211 on a nearly party-line vote, would expand alternative coverage options like association health plans and individual coverage health reimbursement arrangements.
It would also fund cost-sharing reduction payments to decrease out-of-pocket costs and deductibles for lower-income ACA enrollees, and implement transparency requirements for pharmacy benefit managers.
However, the bill makes no mention of extending the enhanced premium tax credits for ACA plans. The subsidies, first enacted during the COVID-19 pandemic, allowed many low-income beneficiaries to pay nothing for coverage while improving affordability for middle-income enrollees.
The financial assistance is set to expire at the end of the year, causing premiums on the exchanges to more than double and likely pushing millions of beneficiaries to drop their coverage.
The looming deadline has roiled Washington for weeks. The issue was at the center of a historically long government shutdown this fall, though the impasse ended without a deal. Democrats support extending the subsidies to avoid a looming affordability cliff, but Republicans have largely argued the financial assistance is too pricey and increases opportunities for fraud.
Still, the GOP has experienced some infighting on how to address the lapsing subsidies. On Wednesday, four moderate Republicans joined Democrats on a discharge petition that would force a vote next month on extending the subsidies.
But the move is unlikely to advance, and the Senate last week rejected its own legislation that would have preserved the premium tax credits for three years.
The expiration of the subsidies will add new financial pressure for providers, who are expected to see revenue decline and uncompensated care costs rise as a result.
“As premiums rise, many will have no choice but to drop their insurance. This will increase the number of uninsured, raise costs for patients and providers, and further strain the entire health care system — creating avoidable financial instability for families and communities across the country,” Mary Haddad, president and CEO of the Catholic Health Association, said in a statement Wednesday.
The Federation of American Hospitals also called on Congress to act in the new year to extend the tax credits.
“Lawmakers from both sides of the aisle are leaving town without addressing the number one issue for families in every community across the country: skyrocketing health care premiums come January 1st,” Charlene MacDonald, executive vice president of public affairs at the FAH and the group’s incoming CEO, said in a statement Wednesday. “It shouldn't be this way — but make no mistake — this issue is not going away.”
