With the GOP regaining control of Congress, Republicans are particularly seeking to reduce health care spending Looking at Medicaid cuts and job requirements. While these fights are almost certainly going to garner a lot of coverage, it’s important to pay attention to some of the less splashy principles of chopping block as well.
This may not be the main program. You may not have even heard of some of them. But America’s social safety net depends on a patchwork of many different, sometimes low-profile, subsidies that many of us take for granted. Some of these programs may appear only as a small line item on a spending bill that few people notice, and that makes it easier for lawmakers to slowly but surely dismantle our social safety net.
Here’s an example: For millions of families, health care costs could rise as crucial subsidies expire at the end of next year. Some families will see their premiums increase by thousands of dollars; Others may lose their insurance altogether.
In 2021, President Joe Biden signed into law the American Rescue Plan Act, which included a provision that increased the premium tax credit — a part of the Affordable Care Act (ACA) that subsidizes the cost of premiums for some low- and middle-income earners. Families are an improvement on the Biden era, which Basically the number of people is expanding Those eligible for the tax credit, originally set to expire at the end of 2022, but Congress They have been extended till 2025 When it passed the Inflation Reduction Act. (For families at or slightly above the poverty line, the extended tax credit subsidizes the full premium. Those making more than 400 percent of the poverty line — who were previously ineligible for the subsidy — it Capping their premiums at 8.5 percent of their income.)
The increased premium tax credit contributed to a record number of insured people in the United States. In February 2021, before Congress expanded the premium tax credit, 11.2 million people were enrolled in health coverage through the ACA marketplaces. By 2024, that number Up to 20.8 million people shot.
There are many reasons for the dramatic increase in marketplace coverage — including Millions of people were not enrolled Medicaid coverage shifted after the end of the Covid emergency measures and to other forms of insurance, including the marketplace — but the enhanced premium tax credit played an important role. Its expansion was the main reason more people were able to enroll in health care coverage from the ACA Marketplace, According to the Kaiser Family Foundation.
If Congress allows the extended premium tax credits to expire, millions of people could see a noticeable increase in out-of-pocket costs. Many would likely lose their coverage, and regardless of how much more would be at risk if Medicaid were cut as well. For low-income families, especially those living just above the poverty line, it can be a nightmare.
Who is at risk of seeing higher costs?
Expanded tax credits didn’t fix the health care system, and you probably don’t remember hearing candidates talk about them much during the election. But they proved to be an important, if small, improvement to the system already in place, and had immediate and tangible results in getting more people insured.
“The premium tax credit improvements have really led to huge out-of-pocket savings for people – $700 [per year] on average,” said Gideon Lukens, a senior fellow and director of research and data analysis at the Center on Budget and Policy Priorities (CBPP). “They were really the primary reason that enrollment in the marketplace increased … and the uninsured rate dropped to an all-time low.”
So far, around 93 percent of people Enrollees through the ACA Marketplace receive a premium tax credit. But if this extension of tax credit is not extended or made permanent, 3.4 million people According to the Congressional Budget Office could lose their insurance. The Urban Institute assumes the same 4 million people could lose their insurance If Congress doesn’t act on time.
According to the center of budget and policy prioritiesBlack and Latino people have benefited the most from the increased premium tax credit, so they will likely be disproportionately affected by the cuts. For example, Marketplace enrollment increased 186 percent among black people and 158 percent for Latino people after the expanded premium tax credit went into effect. In contrast, market enrollments for other ethnic groups increased by 63 percent over the same period.
More than 19 million people would see higher premiums without the increased tax credit. Many families may see costs increase significantly, especially if they have moderate incomes or older members, who already have to pay higher premiums. A 60-year-old couple earning $82,000 a year, for example, could see their monthly premiums triple, meaning they’d owe an extra $18,400 out of pocket. CBPP Report.
Looking ahead
The GOP will be responsible for deciding whether to expire or extend the extended premium tax credits Given the success of the tax credits — leading to a record-high enrollment rate — it would be a mistake to let the enhancements lapse.
While the GOP may not necessarily be all that interested in expanding social programs — it tried and failed to repeal the Affordable Care Act during Donald Trump’s first term — the benefits of expanded premium tax credits are very real, and if they go away, millions of Americans will quickly notice. . That could give Democrats room to pressure Republicans on a deal that would, ideally, make those increases permanent. So while lawmakers may fight tooth and nail to reduce or avoid cuts to major programs like Medicare or Medicaid, they should also remember that even these small adjustments are worth fighting for, including an expanded premium tax credit or, say, What can people buy with food stamps?This provision still lowers the cost of living for millions of families.
With Republicans regaining control of Congress and the White House, it’s easy to lose hope that any meaningful anti-poverty efforts will happen at the federal level. But even if there are election results, they are not permanent either. That’s why, in the coming months, I’ll focus on what’s experimenting with anti-poverty policies around the country — experiments that could one day be replicated at the federal level when it’s more politically feasible. Have you benefited from state or local programs that you think would be a good model for the rest of the country? If so, I’d love to hear from you. Email me at abdallah.fayyad@vox.com.
One more thing
Meet the 2024 Future Perfect 50! Vox’s third annual celebration of people who are envisioning and building a better future, including those who are fighting global poverty.
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