The U.S. Capitol. Credit: Christian Hinkle/Shutterstock
Sen. Bill Cassidy, the chairman of the Senate Health, Education, Labor and Pensions Committee, thinks members of Congress might still pass legislation that will keep millions of consumers from facing big increases in bills for individual and family health insurance Jan. 1, 2026.
The Louisiana Republican talked about a possible way forward Wednesday, at a committee hearing in Washington on health care costs.
"We should focus our minds on what can get done by three weeks from now," Cassidy said. "That means we have to build on what we have. Neither side's going to particularly like that, but, if we're going to do something in three weeks, we've got to do it in three weeks."
Cassidy said Democrats could push for government-run health care system proposals that would fail, and Republicans could push for proposals of their own that would fail.
Instead, Cassidy said, members of parties should try to move toward a third, compromise approach, such as keeping the current Affordable Care Act health insurance subsidy system largely intact but sending some of the ACA subsidy money into consumers' individual health accounts.
"President Trump supports the concept of this third approach, which clearly strengthens its chance of passing," Cassidy said.
What it means for employers: The witness list at the hearing included Joel White, president of the Council for Affordable Health Coverage, and Marcie Strouse, an Iowa benefits advisor who is president of the Iowa chapter of the National Association of Business and Insurance Professionals but who identified herself as speaking on behalf of the National Federation of Independent Business.
Both Strouse and White emphasized the need to help small employers afford health coverage by eliminating many of the current coverage requirements and increasing access to other options.
White, for example, called for making it easier for employers and others to team up to buy health coverage through association health plans, easing restrictions on access to short-term health insurance and passing the "CHOICE Act" bill, which would expand the individual coverage health reimbursement arrangement program.
One implication is that CAHC and NFIB may be helping to create and round up support for an ACA premium subsidy fix bill, and that any legislation that passes could include an AHP provision, a short-term health insurance provision or health account provisions.
The Senate HELP Committee streamed the hearing live on the web and posted a recording of the video on its website.
The backdrop: Members of Congress are facing a Jan. 1 health insurance cost cliff because of choices made during the COVID-19 pandemic.
Originally, starting in 2014, the Affordable Care Act made premium tax credits and subsidies for out-of-pocket costs available to people who bought individual or family coverage from HealthCare.gov or another ACA public health insurance exchange and had income under 400% of the federal poverty level, or $62,600 for an individual living in most of the United States this year.
Congress responded to the COVID pandemic by making the subsidies more generous and offering them to any exchange plan users if the cost of standard coverage would exceed more than about 10% of their income.
The "enhanced premium tax credit" rules are set to expire Dec. 31.
For some low-income and moderate-income exchange plan users, the enrollee's share of exchange plan premiums could double or triple.
For consumers with income over 400% of the federal poverty level, their share of the premiums could increase even more.
The politics: Conservative economists say the current ACA framework pushes the full cost of health coverage higher, rather than lower.
Some conservative Republicans in Congress, and President Donald Trump, have talked about passing a temporary ACA premium subsidy bill that would cut off access to subsidies for people with a very high income and put at least some subsidy money in consumers' own flexible spending accounts, rather than sending all of the subsidy money directly to health insurers.
Some Democrats, meanwhile, have objected to the idea that putting health insurance subsidy money in consumers' FSAs could lead to a chance for banks and asset managers to generate high FSA administration fees.
Other senators focused on the problems facing their constituents now.
At the Senate HELP hearing, Sen. Lisa Murkowski, an Alaska Republican who sometimes votes with the Democrats on health policy issues, reported getting a text from a friend over the Thanksgiving break who said her family's premiums were about to increase to $3,000 per month in 2026, from less than $500 per month now.
"I think we're going to need a short-term extension, but I think we can put reasonable caps on it," Murkowski said. "But we've got to be looking long-term at how we ultimately reduce these costs of care."
The Democrats' bill: Sen. Chuck Schumer, D-N.Y., the Senate minority leader, said on the Senate floor today that he and colleagues expect to introduce a simple bill that would extend the current ACA subsidy rules for three years soon and force the Senate to bring the bill up on the floor for a vote next week.
Observers are predicting the bill will fail, but efforts by Republicans to lock in opposition to the Democrats' bill could give Republicans like Cassidy and Murkowski a chance to help shape any health insurandce legislation that the Republicans propose.
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