Democrats' plan to increase Affordable Care Act subsidies and extend COBRA insurance will cost the federal government more than $54 billion over the next decade and result in less than 2 million more people gaining health coverage, according to a new federal report.
On Feb. 11, the House Ways and Means Committee approved a plan to subsidize coverage in 2021 and 2022 for higher-income people who don't qualify for ACA subsidies currently, boost contributions to lower-income people who already qualify for financial help and max out allowances for anyone collecting unemployment benefits in 2021. The committee also aims to block the Internal Revenue Service from clawing back money from people who underestimated their 2020 income and received too much in ACA subsidies, and subsidize premium costs for COBRA coverage for some workers.
The Congressional Budget Office and Joint Committee on Taxation estimate these moves will reduce the number of people without insurance by 800,000 in 2021, 1.3 million in 2022 and 400,000 in 2023. But they will come at a cost of more than $54 billion over the next decade.
Democrats' plan has the support of the Affordable Care Act Coalition, a newly-formed group comprised of eight organizations across the healthcare industry that advocates for increased subsidies for consumers and states that expanded Medicaid.
"While we sometimes disagree on important issues in healthcare, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all," the Affordable Care Act Coalition said in a statement. "Achieving universal coverage is particularly critical as we strive to contain the COVID-19 pandemic and work to address long-standing inequities in healthcare access and outcomes."
Agencies report that increasing premium tax credits for those currently eligible and expanding eligibility to those with incomes greater than 400% of the federal poverty line will increase the federal deficit by $35.5 billion through 2030.
New marketplace enrollees will account for $13 billion of the estimated increase in premium tax credits and existing marketplace enrollees would account for the remaining $22.5 billion, according to the report. Offering full subsidies to people receiving unemployment benefits would cost another $4.5 billion, and allowing people to avoid paying back excess subsidies from 2020 would add another $6.3 billion, the agencies said.
Increasing federal subsidies for workers who recently lost their job and qualify for COBRA coverage would add another $7.8 billion to the federal deficit through 2030. By growing the federal allowance available, the agencies estimate an additional 2.2 million people would enroll in COBRA coverage.