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The Hill
18 hours ago
- The Hill
Obamacare faces a subsidy cliff — don't bail it out without reform
The controversy over the 2010 Affordable Care Act dominated Barack Obama's presidency. The implementation of ObamaCare caused health insurance premiums to soar and nearly collapsed the market entirely. The Biden administration responded by flooding the system with expanded federal subsidies, which are set to expire at the end of 2025. To stop premiums for older workers with pre-existing conditions from suddenly leaping by $10,000, Republicans will need to extend part of this additional funding. But in return, they should insist on reforms to allow healthy Americans to purchase better value insurance with their own money. The Affordable Care Act required health insurers to cover individuals with pre-existing conditions at the same price as enrollees who signed up before they got sick. As a result, premiums more than doubled, millions of healthy enrollees dropped coverage and many insurers abandoned the market. The Affordable Care Act kept the individual health insurance market from falling apart completely by providing subsidies to low-income enrollees. But individuals earning more than $62,600 in 2025 would have faced full premiums without any assistance. Those unsubsidized enrollees felt the full pain of the Affordable Care Act's premium hikes. The legislation allows insurers to charge older enrollees up to three times what they do the youngest, and so unsubsidized premiums for near-retirees can be huge. This year, the benchmark unsubsidized premium for a 61-year-old individual in Washington, D.C., is $15,402 per year. Rather than fix ObamaCare's structure, the newly-elected Democratic Congress in 2021 threw money at the problem with the American Rescue Plan Act. By expanding eligibility for subsidies to higher earners, the act reduced the cost of health insurance for a 61-year-old earning $70,000 from $15,402 to $5,950 — with federal taxpayers covering the difference. That legislation also expanded the generosity of subsidies for lower earners. Those earning $22,000, who would have contributed $756 to the cost of insurance under the original Affordable Care Act, would get it entirely paid for by the federal government. This approach has been hugely expensive. In May 2022, the Congressional Budget Office estimated that subsidies for the Affordable Care Act would cost $67 billion in 2024. Last June, following a renewal of the American Rescue Plan Act's increased subsidies, the Congressional Budget Office's revised cost estimate for 2024 surged to $129 billion. A recent Paragon Institute report found that this leap in cost owed much to a surge in enrollment among those who received coverage free of charge. Paragon estimated that such enrollees accounted for nearly half of new enrollment, and that 5 million people may have misreported their income to claim free coverage, costing taxpayers an additional $20 billion. Insurers eagerly welcomed the influx of new healthy enrollees, who had not deemed it worth purchasing insurance from the individual market until the federal government paid the entire price. Such newcomers proved enormously lucrative, as they used less medical care than existing enrollees but generated the same revenue. Democrats, who received twice as much in campaign contributions as Republicans from Blue Cross Blue Shield in 2024, eagerly boasted about reducing the number of uninsured Americans, with little concern for the cost. The expiry of the American Rescue Plan Act subsidies is now looming again, set to expire at the end of 2025. It will be up to a Republican president and Republican-led Congress to find a way forward. Fiscal conservatives have little appetite to pay for renewing all the expanded ObamaCare subsidies. But nor will they feel comfortable letting the American Rescue Plan Act's enhanced subsidies expire entirely, as this would result in a $10,000-per-year premium hike on thousands of middle-income near-retirees. Congress should focus on targeted support by eliminating the cap on eligibility for the Affordable Care Act's original subsidies, which limit premiums at 9.5 percent of income, to avoid a sudden benefit cliff for those with incomes just above $62,600. But they should also let other expansions of subsidies expire. In return, Republicans should insist that Americans be allowed to obtain discounted premiums if they purchase insurance before they get sick. In 2017, President Trump allowed Americans to do this by purchasing short-term insurance. However, in 2024, the Biden administration limited the duration of these plans to four months. This came following pressure from big insurers, who claimed that allowing the expansion of such plans would prevent them from cross-subsidizing enrollees with pre-existing conditions by overcharging those who signed up while healthy. In reality, the restriction of these affordable plans has served mostly to inflate insurers' profits. Healthy enrollees remain able to purchase short-term plans afresh every few months; it is only those who subsequently become sick who are deprived of coverage. Regulatory protections for the long-term coverage of enrollees in non-ObamaCare plans should be strengthened; not weakened. Furthermore, with the extension of the American Rescue Plan Act's premium cap, federal subsidies taxpayers directly subsidize most enrollees. It is therefore unnecessary to also prohibit healthy enrollees from obtaining insurance plans which offer long-term coverage at good value for their money.
Time Business News
2 days ago
- Time Business News
Debbie Wasserman Schultz on the Legislative Frontlines
Debbie Wasserman Schultz has built a reputation in Congress as a determined advocate for civil rights, healthcare reform, and public safety. Representing Florida in the U.S. House of Representatives since 2005, she has consistently championed legislation that addresses the needs of vulnerable communities while working to strengthen the nation's democratic values. Throughout her career, Debbie Wasserman Schultz has been a strong defender of civil rights. She has taken bold positions on issues ranging from voting rights to LGBTQ equality. As a member of Congress, she has supported legislation aimed at expanding voter access, opposing discriminatory practices, and ensuring that every citizen has an equal voice in the democratic process. Her advocacy extends to protecting religious and ethnic minorities. Most recently, she has been at the forefront of efforts to create a national strategy to combat antisemitism, working across party lines to address the rise in hate crimes and extremist rhetoric. She views these initiatives not only as a matter of protecting one community, but as a fundamental defense of American democracy. For Debbie Wasserman Schultz, healthcare reform has always been more than a talking point. A breast cancer survivor herself, she has been a leading voice for policies that expand access to preventive care and early detection services. Her leadership on the EARLY Act has helped fund breast cancer education programs for young women, potentially saving thousands of lives through increased awareness and timely screenings. She has also recently introduced the Reducing Hereditary Cancer Act, a bipartisan bill designed to make genetic cancer testing more accessible to Americans who are at risk. By removing financial and coverage barriers, she hopes to create a healthcare system that focuses on prevention and equity, ensuring no patient is denied care because of cost or insurance limitations. In addition to her work on civil rights and healthcare, Debbie Wasserman Schultz has been an advocate for public safety measures that protect communities while respecting individual rights. She has supported common-sense gun safety reforms, investments in law enforcement training, and improved coordination among public safety agencies. Her legislative work also extends to protecting children and families. She has championed laws like the Virginia Graeme Baker Pool and Spa Safety Act, which addresses child drownings by requiring safety standards for public pools and spas. These efforts reflect her broader commitment to legislation that has a tangible impact on everyday lives. While Congress is often marked by partisan gridlock, Debbie Wasserman Schultz has shown an ability to collaborate with colleagues from both sides of the aisle. Her bipartisan efforts on anti-hate initiatives, healthcare reform, and safety legislation demonstrate her belief that meaningful change requires cooperation and dialogue, even among political opponents. This approach has allowed her to move forward on initiatives that might otherwise stall in a divided political climate. By focusing on shared values such as safety, health, and equality, she has been able to advance legislation that benefits a broad range of Americans. As she continues her work in Congress, Debbie Wasserman Schultz remains committed to her core mission: defending civil rights, improving healthcare access, and safeguarding communities. She has made it clear that she sees these priorities as interconnected, with each influencing the strength and resilience of the nation as a whole. Her ongoing legislative efforts, from combating hate crimes to expanding medical testing access, are grounded in a belief that the government should be both responsive and proactive in addressing the needs of its people. This vision, combined with her experience and willingness to work across political divides, positions her as a significant force in shaping policy on some of the most pressing issues facing the country today. For constituents in Florida and for Americans across the nation, Debbie Wasserman Schultz continues to serve as a steadfast advocate, ensuring that civil rights, healthcare, and public safety remain at the top of the congressional agenda. TIME BUSINESS NEWS
The Hill
2 days ago
- The Hill
Hospital at home treatment is working — Congress must now give it a future
During my (Zain's) last year of medical school, I took care of a 70-year-old woman who was admitted for a mild chronic obstructive pulmonary disease exacerbation. She was requiring slightly more oxygen than she was typically on at home and felt short of breath. She began recovering quite well during the first day of her hospital stay — stable, walking short distances and excited to go home. However, she wasn't yet ready to be discharged without any oversight. The typical next step would be to keep her in the hospital another night, continuing her exposure to the risks of inpatient medicine: hospital-acquired infection, exhaustion from the persistent monitor beeps and flashes, and another night away from the comfort of her family. However, this time was different. Instead of another inpatient night, she and her family were approached by the health system's Hospital at Home coordinator with what seemed a radical idea: the opportunity to continue her inpatient-level medical care at home, with appropriate clinical supervision. A pulse oximeter, blood pressure cuff, and tablet for virtual monitoring were delivered to her home that afternoon. A nurse visited twice daily to check vitals and administer medications, and a physician conducted a video check-in each morning. Her labs were drawn at home and her care team was on call 24/7. She was given the opportunity to heal in the comfort of her own home — and it worked. This patient's story represents the promise of hospital at home — a model of care that delivers inpatient-level treatment inside of a patient's home. A homage to home visits by physicians a century ago so richly depicted in literature and film, contemporary technology has enabled a new version of care in the comfort of patients' homes. Hospital at home has been shown to be safer for eligible patients. Eligible patients enrolled in hospital at home saw reduced mortality rates and fewer hospital-acquired infections across the board. A Mount Sinai study found hospital at home patients were nearly 50 percent less likely to experience a hospital readmission. Hospital at home also has the added benefit of reduced health care costs for the patient. But, Congress has to act — otherwise the program is at risk. The current expansion of the hospital at home model began out of necessity. In 2020, at the height of the COVID-19 pandemic, Congress and the Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver. It allowed hospitals to deliver full inpatient care to patients at home while still receiving Medicare payment under the usual Diagnosis-Related Group system — key to generating inpatient capacity when such high demands were placed on it. It also protected non-COVID-19 patients from potential infections. This emergency waiver offered hospitals a lifeline during the height of the pandemic — but it also revealed a sustainable care model with long-term potential. In December 2022 — when the initial waiver was set to expire — Congress extended it for an additional two years as part of the Consolidated Appropriations Act. It was extended again until 2024 in the American Relief Act. Now, the CMS waiver was extended until Sept. 30 as part of continuing resolutions passed earlier this year. Importantly, key legislation was introduced in the previous 118th Congress and, recently, the 119th: the Hospital Inpatient Services Modernization Act. These bipartisan bills will extend the Acute Hospital Care at Home waiver and lay the foundation for a more permanent regulatory framework. They expand eligibility, standardize oversight and give CMS the tools to collect data and evaluate long-term research outcomes. This bill should be debated, passed and signed — quickly. With the increased proportion of older Americans, our health care system continues to face added stresses at all levels. However, without legislative action, the entire program could vanish in September 2025 when the temporary waiver expires. Apart from large academic institutions with established programs, hospitals are unlikely to have the resources to invest in home-based care infrastructure without the waiver for reimbursements in place. The cost for smaller hospitals to implement telemonitoring systems and mobile nursing fleets is substantial, especially with an uncertain policy environment. This would have negative effects on especially rural communities, that already face significant health challenges and issues accessing appropriate care. A stable regulatory framework is the minimum needed to realize this model's full potential. Congress must pass the Hospital Inpatient Services Modernization Act and build a pathway toward a permanent policy solution. The data is compelling, the infrastructure is growing, and the need is real. Hospital at home is modernizing medicine, and it's time for legislation to catch up. Hospital at home has already proven it can work — what we need now is the political will to let it thrive. Zain Khawaja is an emergency medicine physician at Northwestern University. Manav Midha is a researcher at the USC Schaeffer Center for Health Policy and Economics.
