Our second-longest government shutdown in history grinds on. I suspect most people really don’t fully understand the details of the current fight. If it lasts much longer, millions of people will soon get a quick education.
At the heart of the fight sits the Affordable Care Act’s (ACA) health insurance premium subsidy. This subsidy is officially known as the Advance Premium Tax Credit. It doesn’t exactly roll off your tongue, does it? Just think of it as a mechanism that provides help to make health insurance more affordable for about 1 in 10 households in the US.
Almost five years ago, the Biden administration sweetened the ACA’s health insurance premium subsidies. In two months, those sweeteners are set to expire. Republicans chose not to extend the “enhanced” premium subsidies when they pushed through their new tax bill in July. Democrats are now demanding an extension. Naturally, this government shutdown is their only political leverage.
It’s worth explaining how the premium subsidy actually works to get the sense of urgency. Under the ACA, you can buy health insurance through a public marketplace. If you qualify, you can also receive a government subsidy to reduce the cost. A sliding scale is applied to determine what percentage of your income you can actually “afford” to pay for your insurance coverage. The lower your income, the lower your share of the true cost. The ACA’s premium subsidy then covers the rest of the cost of a “benchmark” Silver plan. If you’re generally healthy, you might even opt for a Bronze plan to make things that much more affordable.
Before Biden’s changes, there was a hard income cutoff to getting any help. If your income exceeded 400% of the poverty line – that’s only about $60,000 for a single person or about $120,000 for a family of four – you were completely ineligible. Even if your premiums would eat up as much as your mortgage payment, you were simply left on your own.
Biden’s enhancements eliminated that cliff and it enabled nearly two million “higher-income” people to get some help. Beyond abolishing the cliff, the enhancements also lowered the definition of what’s really affordable.
If we go back to the old rules, it means higher premiums for millions of households who might still qualify for help. It also means massive premium hikes for those who make even $1 over the cliff of 400% of the poverty line. It’s a really big deal.
Now, here’s the political kicker. Next year’s ACA insurance renewal season starts next week. Today, insurance companies are about to publish their rates and their agents are currently in the dark. The sticker shock will soon be crystal clear.
While the expiration of the ACA’s enhanced premium subsidies might seem irrelevant for the fortunate majority with employer health insurance or Medicare coverage, for the nearly 15 million households who really need affordable health insurance, this shutdown fight is about to hit home. Expect a deal soon.