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Speaker 1: Bloomberg Audio Studios, podcasts, radio news.

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Speaker 2: It's a new year, but lawmakers are having the same

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Speaker 2: old fight over Affordable Care Act subsidies. The House of

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Speaker 2: Representatives is expected to vote today on a three year

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Speaker 2: extension of pandemic era subsidies that lowered the cost of

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Speaker 2: insurance for millions of Americans, a proposal that already failed

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Speaker 2: in the US Senate. Those subsidies expired at the end

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Speaker 2: of December, and now a new deadline looms. Americans looking

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Speaker 2: to purchase an ACA plan only have until January fifteenth

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Speaker 2: in most states to choose their insurance for the year ahead.

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Speaker 2: Without the subsidies, those plans are a lot less affordable.

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Speaker 1: The rates are now currently up on average, they're expected

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Speaker 1: to about double. That varies greatly depending on your age

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Speaker 1: and where you live, how much healthcare is available in

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Speaker 1: your area. That's sort of saying.

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Speaker 2: Bloomberg's Caitlin Riley covered Congress and she's been tracking the

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Speaker 2: policy debate and the impact it could have on Americans.

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Speaker 1: About twenty four million people are enrolled in the ACA.

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Speaker 1: Upwards of ninety percent of those people got these enhanced

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Speaker 1: premium subsidies that went into place during the pandemic.

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Speaker 2: Now, many Americans are trying to figure out what insurance

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Speaker 2: they can afford. The rising costs are expected to result

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Speaker 2: in nearly four million people losing healthcare over the next decade,

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Speaker 2: according to the Congressional Budget Office.

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Speaker 1: What I've gotten from people I've spoken to is just

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Speaker 1: a tremendous amount of anxiety and anguish. People seem to

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Speaker 1: be really putting off making a decision because they have

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Speaker 1: only very bad options.

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Speaker 2: One person Caitlin spoke with is Carrie van Mevrin. Carrie

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Speaker 2: owns a management consulting business in Missouri. She's done a

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Speaker 2: lot of work for state and local governments, and small

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Speaker 2: business owners like Carrie are disproportionately reliant on the Obamacare subsidies.

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Speaker 3: I'm fifty four, I have a history of blood class.

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Speaker 3: Last time that I was in the er, if I

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Speaker 3: hadn't had insurance, would have been thirty thousand dollars and

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Speaker 3: that was just an ER visit.

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Speaker 2: Harry has decided to re enroll in ACA coverage for

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Speaker 2: twenty twenty six, but without the guarantee of those subsidies,

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Speaker 2: she's had to choose a new plan with higher monthly premiums.

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Speaker 3: I ended up picking a very high deductible, a plan

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Speaker 3: that has much higher copays, it has much higher out

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Speaker 3: of pocket max. So it becomes a risk policy, not

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Speaker 3: a healthcare policy, because you can't afford to use it.

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Speaker 2: Even as lawmakers face the end of open enrollment next week,

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Speaker 2: my colleague Kaitlin Riley says, it remains uncertain whether Democrats

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Speaker 2: and Republicans can reach a compromise.

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Speaker 1: All of this is still very much a long shot,

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Speaker 1: but we are expecting to see more activity in the

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Speaker 1: coming weeks. And even if all of that fails, because

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Speaker 1: it's a midterm election year, we don't expect this issue

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Speaker 1: to go away.

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Speaker 2: I'm David Gera, and this is the big take from

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Speaker 2: Bloomberg News today. On the show, how an intractable battle

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Speaker 2: over how to lower health care costs could wind up

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Speaker 2: keeping them high. When the calendar flipped to twenty twenty six,

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Speaker 2: the cost of health insurance jumped from millions of Americans.

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Speaker 2: The average premium is expected to increase one hundred and

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Speaker 2: fourteen percent this year, according to KFF, that's a non

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Speaker 2: partisan health research organization.

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Speaker 1: It's a lot of people who are affected by this.

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Speaker 1: It's about seven percent of the total population, though that's

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Speaker 1: not evenly distributed. Enrollments really high in red states, typically

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Speaker 1: in the South that didn't expand Medicaid under the Affordable

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Speaker 1: Care Act. So that's kind of the mix of people

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Speaker 1: we're seeing affected, and I think it's important to distinguish.

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Speaker 1: There are two sets of subsidies. The first set of subsidies,

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Speaker 1: which helps people on the lower income side of the scale,

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Speaker 1: went into place when the law was established. Those will

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Speaker 1: remain in place. The subsidies that we're typically talking about

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Speaker 1: when we talk about this are a set of tax

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Speaker 1: credits that were enacted during the pandemic by Democrats, and

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Speaker 1: those are allocated to the insurance companies in these exchanges

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Speaker 1: to keep premiums lower. For people making less than four

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Speaker 1: times the poverty level. This lowered costs further for them.

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Speaker 1: That subset of people we're already getting subsidies will continue

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Speaker 1: to get some subsidy, it's just a less generous subsidy.

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Speaker 1: It made a huge difference for anyone making more than

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Speaker 1: four times the poverty level, which in twenty twenty five

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Speaker 1: was I think around sixty three thousand dollars a year

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Speaker 1: if you're a single individual. For that group of people,

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Speaker 1: these subsidies are entirely going away, and it creates that Cliff,

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Speaker 1: and those are the people who are going to see

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Speaker 1: like the most drastic increase in their premium costs.

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Speaker 2: Caitlyn, when you're on Capitol Hill talking to Republican lawmakers,

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Speaker 2: what is the argument that they have been making for

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Speaker 2: why they're targeting these subsidies, why they've been in favor

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Speaker 2: of their expiration.

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Speaker 1: The big sort of ideological, principled argument they make is

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Speaker 1: that by creating the subsidy that it's actually driven healthcare

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Speaker 1: costs up. You remove kind of the competitive pressure that

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Speaker 1: might have exercised some moderating force on what these premiums cost.

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Speaker 1: So that's kind of the big ideological argument. I think

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Speaker 1: there's another piece of this that when Obamacare was created,

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Speaker 1: very few of them supported it. It's not become that

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Speaker 1: much more popular with them since these subsidies were created

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Speaker 1: fully along party lines, with only Democratic votes, and I

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Speaker 1: think there's a feeling that this was a temporary program

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Speaker 1: put in place during the pandemic or out of the pandemic.

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Speaker 1: And I think another piece the vices that they don't

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Speaker 1: like the cost. There are a lot of reasons that

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Speaker 1: come up, but I think it's like, really just this

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Speaker 1: deep sort of ideological divide between the parties on healthcare

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Speaker 1: and how to keep costs down.

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Speaker 2: Republicans argue the subsidies are too expensive. Since twenty twenty one,

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Speaker 2: they've driven up Obamacare's costs, and extending them for a

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Speaker 2: decade would cost more than three hundred billion dollars according

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Speaker 2: to the Committee for a Responsible Federal Budget, a nonpartisan

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Speaker 2: fiscal policy organization. President Trump supports an alternative that doesn't

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Speaker 2: involve ACA subsidies.

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Speaker 1: Back in November, there was sort of a trial balloon

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Speaker 1: that got put out seemingly from the White House that

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Speaker 1: would have involved a partial extension, like at least a

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Speaker 1: short term extension of the credits, and then like a

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Speaker 1: shift to like federally funded hsas that would go directly

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Speaker 1: two people enrolled in the exchanges.

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Speaker 2: Hsas health savings accounts. President Trump promoted the idea again

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Speaker 2: in a speech to Republican House members this week.

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Speaker 4: Let the money go directly to the people. It goes

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Speaker 4: in a healthcare account. It does. There are numerous things

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Speaker 4: you can do, but you have to let no money

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Speaker 4: for the insurance companies.

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Speaker 1: You know, I'm going to meet with the Republicans in

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Speaker 1: the Senate have put that plan forward, held a vote

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Speaker 1: on the floor. It needed sixty Obviously it didn't get there.

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Speaker 1: That is not going to go anywhere with Democrats if

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Speaker 1: it's proposed as like instead of the tax credits, they

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Speaker 1: like the tax credits.

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Speaker 2: Caitlin says, big picture, the two sides are just very,

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Speaker 2: very far apart.

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Speaker 1: I do think that like the politics here are probably

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Speaker 1: the bigger challenge to overcome in terms of reaching a

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Speaker 1: compromise versus like any single provision we're seeing in some

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Speaker 1: of the bipartisan proposals that have been put.

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Speaker 2: Out coming up the sticking points making a deal so difficult,

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Speaker 2: and why extending or changing the subsidies at this point

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Speaker 2: could create a new set of challenges. Bloomberg's Kaitlin Riley says,

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Speaker 2: the ideological divide we were just talking about, the vastly

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Speaker 2: different approaches to healthcare by Republicans and Democrats, is making

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Speaker 2: it hard for politicians to compromise within.

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Speaker 1: The center of both parties. I think you could get

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Speaker 1: to a place that's like a three year extension, maybe

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Speaker 1: a straight extension in the first year, maybe some income caps,

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Speaker 1: maybe some minimum premium payment that would get rid of

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Speaker 1: what Republicans see as like a gateway to a lot

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Speaker 1: of fraud within the system, which is people signing like

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Speaker 1: not realizing they've been signed up for really poor care

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Speaker 1: that costs nothing, and then having like brokers and insurance

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Speaker 1: companies continue to collect the subsidy.

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Speaker 2: But Caitlin says, just like the majority of Republicans don't

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Speaker 2: want to see these subsidies extended under any circumstance, many

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Speaker 2: Democrats are also taking a firm line.

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Speaker 1: I think there are a lot of Democrats rats who

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Speaker 1: feel that they're winning the political debate on this and

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Speaker 1: it's resonating with voters and feel like we want to

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Speaker 1: clean extension or we want missing.

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Speaker 2: Another key issue that could become a sticking point is abortion.

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Speaker 2: Many Republicans want of ban insurance plans that cover abortion

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Speaker 2: from receiving potential ACA subsidies. Most Democrats do not, and

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Speaker 2: even President Trump encouraged Republicans to be flexible on abortion

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Speaker 2: in a speech on Tuesday.

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Speaker 4: You gotta be a little flexible. You gotta work something.

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Speaker 4: You got to use ingenuity, you gotta work.

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Speaker 2: Four House Republicans did cross party lines to force a

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Speaker 2: vote on the Democrats proposed three year extension. That vote

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Speaker 2: is expected to take place today. A question of mechanics.

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Speaker 2: If Congress were at this point to renew these subsidies,

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Speaker 2: how would that impact existing twenty twenty six plans and

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Speaker 2: people who are maybe still trying to catch the end

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Speaker 2: of the open and Roman period right now.

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Speaker 1: I do think we're entering into period of where it

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Speaker 1: becomes a real logistical challenge. I believe that a lot

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Speaker 1: of exchanges and insurance companies had plans in place in

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Speaker 1: case there had been a clean extension. One criticism we've

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Speaker 1: heard from Democrats of a bipartisan compromise that makes changes

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Speaker 1: is that, like, it would just create such a logistical

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Speaker 1: nightmare if now you're adjusting to a subsidy that looks

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Speaker 1: different than the one that just expired. And even from

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Speaker 1: some moderate Republicans who seem interested in reaching a deal,

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Speaker 1: you have seen some acknowledgment that, like, maybe for the

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Speaker 1: first year you would just extend them as is and

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Speaker 1: then phase in modifications later. What likely would have to

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Speaker 1: happen if they reach a bipartisan compromise certainly after January fifteenth,

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Speaker 1: and a lot of the plans that have percolated include

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Speaker 1: this is you would see some extension of the open

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Speaker 1: enrollment period to allow for people to get better coverage

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Speaker 1: or sign up for like you would probably have to

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Speaker 1: see some change to open enrollment to accommodate this.

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Speaker 2: We're at a moment where lawmakers are looking headlong at

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Speaker 2: another budget fight, just weeks away from the prospect of

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Speaker 2: another government shutdown. Do you have any sense of whether

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Speaker 2: or not these sub seats could become a sticking point

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Speaker 2: in that next big spending fight, or are lawmakers from

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Speaker 2: both party kind of content to leave that behind having

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Speaker 2: done that just a few months ago.

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Speaker 1: Everything could change very quickly. But the impression I was

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Speaker 1: getting before the break was that neither party really wants

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Speaker 1: another government shut down. I get the sense that Democrats

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Speaker 1: felt like they held out as long as they could

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Speaker 1: to try to force action on this during the previous

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Speaker 1: government shutdown, and that doing that again would kind of

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Speaker 1: be fruitless. The deadline is also occurring after open enrollment

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Speaker 1: has already closed. I don't expect this to play a

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Speaker 1: huge role in the next set of negotiations to fund

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Speaker 1: the government.

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Speaker 2: Farther off, but not many months farther off. It is

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Speaker 2: the midterm election. Here we are in twenty twenty six

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Speaker 2: of interim election year. How is that coloring this debate

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Speaker 2: as we get closer to that.

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Speaker 1: I think Democrats are very eager to run on this issue.

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Speaker 1: I expect we will continue to hear a lot more

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Speaker 1: about this, but really plays well into the affordability pitch

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Speaker 1: they're making to voters, and felt was very successful and

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Speaker 1: off your elections in November. So this is something that

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Speaker 1: we expect to keep hearing about even if they don't

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Speaker 1: settle on a solution.

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Speaker 2: Meanwhile, people like Carrie van Mevrin are preparing for the

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Speaker 2: worst case scenario.

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Speaker 3: I know dozens of other small business owners as well

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Speaker 3: as families who some are just going to cross their

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Speaker 3: fingers and hope that they can get through until there's

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Speaker 3: better changes.

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Speaker 2: Carrie is already thinking about the difficult choices she may

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Speaker 2: have to make if she notices signs of another blood clot.

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Speaker 2: She says she'd have to think carefully before going to

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Speaker 2: the hospital. With her new ACA plan, next time I have.

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Speaker 3: The symptoms, do I take a chance and hope that

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Speaker 3: it's not or do I go to the hospital and

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Speaker 3: deal with the consequences financially and that you know, I

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Speaker 3: could lose my.

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Speaker 2: Home This is the Big Take from Bloomberg News. I'm

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Speaker 2: David gurat. To get more from The Big Take and

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Speaker 2: this episode, make sure to follow and review The Big

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Speaker 2: Take wherever you listen to podcasts. It helps people find

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Speaker 2: the show. Thanks for listening. We'll be back tomorrow