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In his latest column, President and CEO Dr. Drew Altman shows how spiking premiums, which may come if the enhanced ACA tax credits are not extended, will hit people in the context of their family budgets, alongside rising costs for food, housing and utilities. For some families, their new health care costs could far exceed what they pay for food, affecting their economic security and potentially their vote.
Trump has long talked about making the ACA less expensive, but the question is less expensive for whom
This election is a choice in health between aggressive incrementalism and a sharp right-hand turn in federal policy and spending, but ... no one should doubt the capacity of our system and institutions to thwart dramatic change in any direction.
The Health Insurance Marketplace Calculator, updated with 2024 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).
In a new column, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”
The debate over these enhanced tax credits can be seen as a proxy for the broader public’s concerns about health care affordability which may be why the public is largely in favor of extending these subsidies – even as overall views of the ACA are still very polarized.
Since the enhanced premium tax credits became available in 2021, ACA Marketplace enrollment has increased significantly in some red states, and 57% of enrollees now live in Republican congressional districts.
The ACA enhanced premium tax credits expanded financial assistance to more Marketplace enrollees, an expansion that was especially helpful to older middle-income enrollees, who would see the largest increases in out-of-pocket premiums if the enhanced credits expire.
Republicans are not talking about repealing and replacing the ACA anymore, and the budget reconciliation bill doesn't do that, at least not directly. However, the bill would restrict health insurance for many people who have been helped by the ACA, and it would be the biggest rollback in federal support for health coverage ever.
Vance’s debate comment likely refers to state reinsurance waivers, largely approved by the Trump Administration. These waivers aimed to lower unsubsidized premiums by offsetting insurer costs for very sick enrollees.
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