A record number of people in the United States are purchasing health insurance through the Affordable Care Act, also known as Obamacare, according to government data. Despite record registration numbers, experts warn that coverage for millions of people could be at risk depending on the outcome of November's presidential election.
Former President Donald Trump reiterated his threat to repeal the health law if he wins a second term. Additionally, if Republicans take control of Congress, experts say they are likely to lapse the discount system that made Obamacare more affordable for millions of people.
“This election has a huge impact on health,” said Chris Meekins, a health policy research analyst at investment firm Raymond James.
A KFF poll released Wednesday found that concerns about health care costs are the main reason for negative views about the U.S. economy. Almost three-quarters of adults are worried they won't be able to pay their medical bills. And 50% of Americans, including nearly a quarter of Republicans, actually want the next president and Congress to expand the ACA's activities. A new poll shows just one-third of adults support scaling back the law (14%) or repealing it completely (18%).
More than 21 million people have enrolled in 2024 health insurance plans through Obamacare as of Jan. 24, with 16 million total enrollees already in the 2023 enrollment period, according to the latest data from the Department of Health and Human Services. exceeds. .
Some of the surge in enrollment is due to people losing Medicaid coverage, Meekins said, but much of it is in response to government-backed subsidies passed through the Inflation Control Act. Ta.
The subsidies, which significantly lower monthly premiums, are available to individuals and families who would otherwise pay more than 8% of their annual income in Obamacare premiums. (For example, for a 50-year-old couple with an annual income of $70,000, premiums would cost about $430 per month, down from $1,333 per month without subsidies, according to KFF, a nonpartisan group that studies health policy issues.) ).
The grant was originally passed as part of the 2021 coronavirus relief bill, the American Rescue Plan Act, and was set to run for two years. It was extended for three years in 2022 based on the Inflation Control Act.
But those discounts are scheduled to expire at the end of 2025 unless Congress extends them again, which is unlikely under a Republican-controlled Congress and president, Meekins said.
“If we had a Republican president, it would be very unlikely that the subsidy expansion would continue,” he said.
Lawrence Gostin, director of Georgetown University's O'Neill National Institute for Global Health Law, said more than 3 million Americans could become uninsured if Congress fails to extend the subsidies, adding that lower premiums could lead to more than 3 million Americans becoming uninsured. Signups have increased significantly over the past decade in states like Florida and Texas, which he added are helping people in Republican-led states.
KFF President and CEO Drew Altman said there are already signs that provisions strengthening Obamacare and the health care law could be in jeopardy.
Altman said Trump, the likely Republican presidential nominee in the 2024 election, is threatening to repeal the health law again. In November, President Trump said on social media, “Obamacare sucks!!!” And we want to replace that with better medical care.
Altman said that while a complete repeal of Obamacare is unlikely, “if Republicans control every branch of the government and Trump becomes president, it will be difficult to continue the subsidies.”
Without the subsidies, he said, people who get insurance through Obamacare plans could pay hundreds of dollars more each month, making it increasingly difficult to pay for insurance.
higher income households will pay more
Gigi Marinchak, 64, of Boyertown, Pennsylvania, is one of the people who would not be able to get Obamacare coverage without subsidies. She runs her own small business and her husband has been retired for three years. Marinchak likes her reporting, she said. She suffered a stroke about 18 months ago, and most of her medical bills were covered, she said.
She currently pays about $12 a month in premiums. Without the discount, it would probably cost a few hundred dollars more, she said.
“Without the subsidy, 100% of my husband's Social Security income would have been used to pay for my health insurance,” she says.
A recent analysis by Raymond James that looked at Obamacare enrollment rates from 2014 to 2024 found that Obamacare enrollment increased from about 11.5 million to 21.5 million people during President Joe Biden's term. .
The analysis found that the largest increases in enrollment during this period were in Republican-governed states such as Florida and Texas. Many of these states did not adopt Obamacare's Medicaid expansion, which increased the number of low-income people eligible for coverage.
John Graves, a professor of health policy and medicine at Vanderbilt University School of Medicine, said that if the subsidies are allowed to expire, high-income families will likely be the most affected.
He said that even if the subsidies extended under the Inflation Control Act expire, Obamacare is still required to provide subsidies to people with very low incomes up to four times the poverty level. Ta.
“If you pay $2,000 one year and $12,000 the next year, all of the increased premiums are paid by the patient,” Graves said.
Alison Farrell, 43, of Phoenix, Arizona, said it would be “alarming” if Congress didn't extend the aid.
Last October, Farrell left his job at a commercial real estate company to start a small business. She currently benefits from extended subsidies under Obamacare.
Farrell currently pays about $700 a month in premiums for herself, her husband and their two daughters. Without her subsidy, that cost would rise to about $1,100 a month.
Ms Farrell said she could afford the high cost, but it was “definitely a burden”.
“Since I quit my job, my income is not what it used to be,” she said. “That would be much harder.”
