Senate Rejects Dueling Healthcare Bills As Affordable Care Act Subsidy Sunset Looms
Without a congressional deal to avoid steep premium hikes, the ACA enhanced tax credits will expire at the end of the year
By Zoë Buhrmaster
The U.S. Senate failed to muster enough votes on Thursday to pass a healthcare resolution as Republicans and Democrats blocked competing measures to avoid steep insurance premium hikes, which are set to hit millions of Americans at the end of the year if enhanced Affordable Care Act (ACA) subsidies expire.
Although the dueling proposals both sought to avoid premium increases, neither bill garnered the 60 votes required to overcome a filibuster and advance out of the Senate.
The GOP-backed proposal, co-sponsored by U.S. Sen. Bill Cassidy of Louisiana and Sen. Mike Crapo of Idaho, would have redirected funds from the Department of Health and Human Services into health savings accounts (HSAs) for those who have bronze or catastrophic exchange plans. The Health Care Freedom For Patients Act would have also opened up eligibility for catastrophic plans to anyone and appropriated funding for cost-sharing reduction payments starting in 2027.
Eligible participants — those ages 18 to 49 earning less than 700% of the federal poverty level — would have received $1,000 in their HSA, and those ages 50 to 64, $1,500. The proposal would have restricted funds being used for abortion or gender transition services.
Republicans applauded the idea for redirecting money from insurance companies back to patients, something that Sen. Steve Daines, R-Mont., has previously said he supports. Daines did not participate in Thursday’s vote as he was on a congressional trip in the Middle East, though his spokesperson Gabby Wiggins said he backed the Cassidy-Crapo proposal.
Senators voted 51 to 48 on the plan, short of the 60 votes required.
The GOP-controlled Senate also nixed the Democrat-backed plan that would have renewed the Covid-19 era ACA subsidies for the next three years in a 51 to 48 vote.
Though the House has signaled that representatives may vote on a healthcare proposal in the coming days, many viewed a deal in the Senate as Congress’ best chance at preventing the enhanced subsidies from expiring at the end of the year.
Without renewal, the 67,000 Montanans who receive ACA tax credits will either lose the subsidies completely or lose the additional Covid-19 era support when the program reverts to pre-pandemic standards. Those who make over 400% of the poverty line will lose the tax credit altogether. Those with incomes below 400% will see premiums rise by hundreds of dollars to over $1,500 per person on average nationwide, according to the nonpartisan health policy research organization KFF.
Katrina Mullan, health economics professor at the University of Montana, noted that those in the lowest income range who don’t qualify for Medicaid and middle-income older folks who don’t yet qualify for Medicare are likely to see some of the biggest jumps in their premiums.
“There are these direct effects on whether people are covered or not and what that means for those individuals, and then there are these more indirect effects on premiums and healthcare costs that comes from having more people not be insured,” Mullan said.
Meanwhile, insurance ratepayers are already beginning to see higher premiums. With a higher cost to entry, it’s likely people who believe themselves to be healthier will drop out, also affecting the rising insurance costs.
“Each person is making a decision based on a combination of what do the trade-offs look like,” Mullan said.