The Affordable Care Act (ACA) has the best enrollment year ever for 2022, setting a pace that kept up through the first third of the year. A record 35.8 million Americans have health insurance through Obamacare, including 21 million people who have qualified for Medicaid under expansion. It’s reduced the uninsured rate to 8.8% in the last quarter of 2021, from 10.3% for the same period the previous year.
Nearly 14 million people—13.6 million—have taken advantage of the expanded subsidies created in the American Rescue Plan (ARP), President Joe Biden’s massive COVID-19 relief package. A substantial chunk of that 14 million people, however, are in for an unpleasant surprise come October just weeks before the election, when they’ll get their premium notices for 2023. The problem is, when Congress passed the ARP, they made the federal subsidy expansion for plans end at the end of 2022, foreseeing an end to the pandemic and planning to make that program permanent—or last at least another several years—in the big follow-up reconciliation bill known as Build Back Better (BBB).
Then along came Joe Manchin, the West Virginia Democratic senator who just loves to throw his weight around and stymie Democratic aims. In a 50-50 Senate, one person can wreck everything (though he gets frequent help from Arizona Democrat Kyrsten Sinema, whose motivations are unclear, beyond raking in as much campaign cash from big corporate donors as possible).
By rejecting that big reconciliation bill because of his flawed understanding of the causes of inflation, Manchin has thrown Democrats for a loop. He also threatens to cause one very specific, damaging form of inflation: health insurance for ACA enrollees.
Washington state Sen. Emily Randall and RuralOrganizing.org's Matt Hildreth talk about what they're seeing and hearing while knocking on doors this week on Daily Kos’ The Brief podcast
His fellow Democrats, and Democratic allies, are well aware of the danger as leadership talks with the spoiler drag on. “It’s not a good look when you’re going into a midterm election,” Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy, told Politico. “There could be some really awful stories about people losing coverage.”
Emily Gee, coordinator for health policy at the progressive-minded Center for American Progress which works closely with the administration and lawmakers added that the expanded subsidies and access was “a major accomplishment,” but warned that “when fall rolls around, people are going to be looking at higher premiums, and that will be what’s salient—not the fact that Congress lowered premiums.”
It could mean a lot of angry voters and another surge in the uninsured rate. Among those hit hardest could be Black voters in red states who didn’t have access to Medicaid, but who could qualify for $0 premiums under the newly expanded ACA. There’s really only one way to fix it, because Republicans aren’t going to help, and that’s using the reconciliation process still available to Democrats that doesn’t allow for a Republican filibuster. The other option would be ending the filibuster, which Manchin and Sinema also won’t let happen.
As of right now, talks are limited to the offices of Majority Leader Chuck Schumer and Manchin. Their staff have been talking, and the two of them have met twice this month, once this week on Wednesday. The White House is staying out of it for now, as are all the other Democrats who’ve tried negotiating with Manchin over the past year and have been burned.
Where Obamacare subsidies land in these talks isn’t clear right now, but the expiring subsidy boost has been a recent focus for the administration. Manchin isn’t really saying, beyond “I don’t know how many times I could say it over and over. […] You get taxes, you get drugs and you could get an energy/climate bill.” That a would seem to preclude ACA subsidies, but it’s Manchin and you can never, ever count on what he says.
White House staff met with ACA exchange directors from several states this week to try to scope out the risks. “Any additional increase on health insurance is just not going to be sustainable for people,” Mila Kofman, the head of D.C.’s Obamacare exchange, said. “They’re going to be choosing between their food, going to work, or keeping a roof over their head.”
Complicating matters, the insurers are going to be setting their rates this summer, ahead of the new enrollment year. That means they need to know basically by the July 4 congressional recess if the expanded premium subsidies are going to be continued.
Manchin says it’s all about inflation and debt reduction for him. “Reconciliation to me is about getting inflation under control, paying down this debt, getting a handle on what’s going on,” Manchin said.
“There’s nothing formal. There’s no false hopes here. There’s nothing. As far as Build Back Better, there’s no talk about any of that. Just saying, how do we get a handle on inflation?” Manchin said. If it’s inflation he’s worried about, he should talk to actual people who are going to have to once again make a choice between having health coverage or the basics of rent, groceries, and gas money if Congress doesn’t act.
RELATED STORIES: