How Democrats could accidentally hit Americans with big health insurance bills right before the midterms

• Millions of Americans could see big hikes in next year’s insurance premiums right before the November midterms.

• That’s if Democrats fail to extend subsidies in a new economic spending bill.

• Manchin seems noncommittal on extending the aid, even though he backed it in the past.

Democrats may be stumbling into a chaotic situation before the November midterms that few are talking about. Millions of Americans are set to see their healthcare bills surge in 2023 with more pandemic aid fading away.

That’s due to the growing possibility Democrats never manage to resurrect parts of their social spending and climate package, which stalled out in the evenly-divided Senate because of resistance from Sen. Joe Manchin of West Virginia.

The Biden stimulus law beefed up subsidies to cut monthly premium costs and make private individual health insurance plans more affordable under the Affordable Care Act (ACA). Democrats intended to extend the program in their defunct Build Back Better bill, setting aside generous new funding to help those without employer-based insurance get coverage in the health insurance marketplace.

Federal unemployment aid expired last year and enhanced ACA subsidies may experience the same fate on December 31. The next open Obamacare enrollment window kicks off November 1, meaning voters would learn about soaring insurance bills only a week before the midterms as they start browsing available plans for 2023 or get notified by insurers.

“It would just be a huge premium shock,” Larry Levitt, executive vice president for health policy at the nonpartisan Kaiser Family Foundation, told Insider, adding people buying individual insurance on the exchanges would pay an average of $800 more per year for coverage.

“Democrats face a potential political headache if they don’t extend the extra premium subsidies,” Levitt said. “People will be finding out about premium increases right before the midterm elections. It will certainly reflect poorly on Democrats. The ACA is their premier domestic achievement of the last decade.”

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Three million people will lose health coverage without the bulked-up federal aid, according to an analysis released last month from the Robert Wood Johnson Foundation. Others will be forced onto cheaper plans carrying deductibles that are sometimes 30x higher — a jump from $200 to $7,000 in those cases. That’s the amount enrollees owe before the insurer starts paying for medical care.

The scale of premium increases will vary due to factors like age, income, and state. But the voters facing eye-popping bills next year tend to be older — the very group that turns out in larger numbers during midterm elections.

“It’s those people who are relatively middle-income, and who are also elderly that are going to face the biggest hit if the subsidies expire,” Emily Gee, the vice president and healthcare policy coordinator at the liberal-leaning Center of American Progress, told Insider.

In Manchin’s home state of West Virginia, some could experience a calamitous increase in their healthcare bills. A 60-year old married West Virginian couple earning $75,000 will see their monthly premium skyrocket by $2,700 if Obamacare subsidies end, according to estimates from healthcare policy expert Charles Gaba.

A similar couple in Arizona would experience a $942 monthly premium hike, per Gaba’s projections. An identical Georgia couple would see their monthly premiums soar by $1,200. Those states are up for grabs in November with very competitive Senate races underway.

Gee added lawmakers must act by midsummer to ensure states and insurers have enough time to set up their enrollment periods, a complex process stretching months. “It’s not like there’s a switch that you can flick in late August or late in the fall to turn on the subsidies,” she said.

A swerving Manchin

Manchin told NBC News in early February that he’s “always been supportive” of ensuring people have access to affordable insurance by keeping the subsidies. But he seems to be b
acktracking, throwing a wrench in any effort to lock in a key component of Democrats’ health agenda designed to fix the law’s affordability problems.

Insider approached Manchin twice this week. Both times he struck a noncommittal tone on whether the Obamacare subsidies should form part of a slimmer Democrat-only package. “My main thing is fighting inflation,” he said on Monday, along with securing “tax reforms.”

On Thursday, he said: “There’s just too much going on. We’re talking about everything.”

Spokespeople for Manchin declined to comment further. Without his vote, Senate Democrats are blocked from reviving a skinnier version of the legislation in the face of unified GOP opposition in the 50-50 Senate.

He has sketched out a package evenly split between new spending and deficit-reduction, along with green energy and short-term fossil fuel measures in the wake of the war in Ukraine. Manchin has also said a chief priority of his is reining in prescription drug costs. It’s not clear what other initiatives fit his narrow demands, but other Democrats say they’re working behind the scenes to get him onboard.

“Holding down premiums will be and has been a major priority for me,” Sen. Ron Wyden of Oregon, chair of the Senate Finance Committee, told Insider.

A Senate Democratic aide drew a comparison to the 2014 midterm elections when rising premiums became a last-minute issue in some races. In Louisiana and Iowa, premium hikes handed Republican Senate candidates another hammer to use against Democrats at the time.

“You’re looking at somewhat a repeat of that,” the aide told Insider, granted anonymity to speak candidly. “It certainly wouldn’t be helpful.”

The GOP Senate candidates won in both states that year: Sen. Joni Ernst clinched the seat in Iowa. So did Sen. Bill Cassidy in Louisiana.

Democrats lost control of the Senate in 2014, only to recapture it last year. They face significant headwinds going into the fall, and spiking premiums could be another popping up in the final stretch. With the Senate and House majorities in play, Republicans will probably not be inclined to cut a deal.

“I don’t see any prospect of Republicans helping Democrats get out of this box,” Levitt said.

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