Millions of Americans are at risk of losing subsidies that help them pay for health insurance next year, following President-elect Donald Trump’s election victory and Republicans’ victory in the Senate.
The subsidies — which expire at the end of 2025 — came from the 2021 American Rescue Plan and increased the amount of help available to people who want to get health insurance through the Affordable Care Act. The American Rescue Plan also expanded the number of people eligible for subsidies, including many in the middle class.
The looming expiration date means the incoming Congress and the next president will have to decide whether to extend it — something Trump and Republicans have already indicated they do not support, said Chris Meekins, a health policy research analyst at investment firm Raymond James.
“If Republicans ultimately win the House of Representatives, in addition to the Senate and the White House, and get a Republican victory, I think there is less than a 5% chance that they will be renewed,” said Meekins, a senior HHS official during Trump’s first term. . Even Democratic control of the House of Representatives is unlikely to save the subsidies, he added.
Several key House races have yet to be decided. As of Thursday afternoon, Republicans had won 209 seats in the House of Representatives, just nine short of the majority, according to an NBC News tracker.
More than 20 million people would receive health insurance through the ACA by 2024, according to the Centers for Medicare and Medicaid Services.
Since the 2021 subsidies went into effect, enrollment in ACA plans with reduced payments has doubled, especially in southern red states, said Cynthia Cox, director of the ACA program at KFF, a nonpartisan research group. healthcare policy.
The Inflation Reduction Act, passed in 2022, extended the subsidies through 2025. In 32 states where data is available, 15.5 million people are receiving the subsidies, according to KFF.
If the subsidies are not extended, the Congressional Budget Office — a nonpartisan agency that provides budget and economic information to Congress — estimates that nearly four million people will lose coverage by 2026 because they cannot afford it. Enrollments will continue to decline each year, with coverage reaching just 15.4 million people by 2030.
A Trump spokesperson did not respond to a request for comment.
It is possible, Cox said, that the current Congress could extend the subsidies during the so-called lame-duck session, although she added that is unlikely.
“The election results make it much less likely,” Cox said. “And what we’re looking at is a significant increase in what people pay for their premiums. It will deliver an average increase of more than 75%. For some people it will be more than double.”
The subsidies are a difficult task for Republicans, Meekins said, because they are expensive. The CBO estimates that it would cost $335 billion over 10 years to permanently extend them.
Moreover, Trump and Republicans in Congress have already said they would make “massive” changes to the health care law.
Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, said if Republicans take full control of Congress, those changes could be significant.
“President Trump will likely cut funding for the ACA plans,” Gostin said. “This means fewer people will know their rights under the law and many will not enroll in ACA health plans. Trump will also likely cut Medicaid funding and support states that refuse to expand Medicaid coverage.”
Gostin also noted that “the ACA’s preventive services mandate is being invoked in the courts.” The mandate requires health insurers to fully cover certain preventive services, including cancer screenings such as colonoscopies and mammograms, at no cost to the patient.
In June, a federal appeals court said the mandate should remain in place until the case is ultimately decided.
Cox said she expects Republicans will continue to dismantle the ACA, similar to Trump’s first term, when they eliminated the tax penalty tied to the law’s individual mandate, which required people to have health insurance or pay taxes. The mandate is technically still in effect, but the penalty has been reduced to zero.
“If Republicans control the House, Senate and presidency, we could see a repeat of 2017,” she said.
Gostin said eliminating the ACA completely will be a challenge even if Republicans control all three chambers.
“The ACA will survive, but only a bare-bones version,” Gostin said.
This article was originally published on NBCNews.com
