Health care premiums will skyrocket if Congress doesn’t renew ACA subsidies. | Unsplash photo
What you probably already know: Approval of the Affordable Care Act is as high as it’s ever been just weeks before the health care subsidies are set to expire unless Congress acts. A West Health-Gallup Center on Healthcare in America poll says 57% of Americans approve of the 2010 landmark legislation, two percentage points up from previous highs of 55% in April 2017 and November 2020. Approval ratings have generally ranged from 37% to 48% since Gallup began tracking public sentiment in 2012. The recent bump was driven largely by independent voters, as 63% now approve of the ACA, a 10-point jump from last year.
Why it matters: The expiration of the subsidies, which end Dec. 31, would disproportionately affect women because they make up more than half of Medicaid users, especially for maternity and family planning. A KFF (formerly known as the Kaiser Foundation) analysis finds that premium payments will soar 114% on average for the 22 million people who now get a tax credit. Twenty-five percent of people KFF surveyed said they would likely go uninsured, while a third said they would most likely shop for a lower-premium health plan. More than half of voters say an increase in expenses of at least $1,000 next year would have a “major impact” on whether and how they would vote in the 2026 midterms.
What it means: The potential loss of benefits coincides with what Politico calls “the rural health Hunger Games.” The Trump Administration has threatened to withhold $50 billion in rural health federal funding unless states pledge to support policies favored by the White House (think changes in SNAP benefits or a reduction in telehealth). The Commonwealth Fund says rural communities face “persistent primary care workforce shortages” as more than 40 million Americans live in areas with too few primary care providers. Limited broadband internet and a lack of public transportation can make it difficult for rural patients to access any kind of care, whether in-person or virtual.
What happens next: All of this is a perfect storm with major implications. NPR reports that the U.S. Senate could vote as early as Dec. 11 on a Democratic plan to extend ACA subsidies for three years, but notes that it is likely to fail. The expanded subsidies were first passed in 2021 by Democrats as part of pandemic relief legislation and were a major reason for the record-long 44-day government shutdown earlier this fall. Support for ACA is stark along party lines: Gallup found that 91% of Democrats support the ACA in general, while only 15% of Republicans do. Republicans may issue a counterproposal, but Democrats are vowing to make the loss of ACA subsidies a central theme in their campaign messaging next year.
