Deal or No Deal? States Prepare for Congress To Act at the Last Minute on Obamacare

Saturday is the day that nearly 24 million customers can start purchasing health plans on healthcare.gov and the state-run Obamacare exchanges. 

Higher prices and uncertainty await many of those shoppers. 

Average premiums are expected to more than double. The directors who manage marketplace enrollment in states including Maryland, California, Pennsylvania, and Idaho told me and my colleague Julie Appleby that people are wondering how they’ll scrape together hundreds — or even thousands — of dollars more next year to pay for these plans. Some people are considering plans with five-figure deductibles, like one Virginia Beach, Virginia, family facing a $20,000 deductible to keep their monthly premiums near $70. 

“They might look cheap premium-wise, but the coverage itself is going to end up costing that family a lot,” Deepak Madala, the director of Enroll Virginia, told me this month. 

Even as Americans weigh high-priced plans, there’s the very real possibility that everything could change if Congress strikes a last-minute deal to extend the subsidies before the end of open enrollment, which runs through Jan. 15 in most states. 

Behind the scenes, the directors of state-based exchanges are drawing up contingency plans. 

In Idaho, the state exchange director says he has “notices ready to go” should Congress work something out. California and Maryland are preparing to temporarily close open enrollment if lawmakers agree to extend the subsidies. 

On Capitol Hill, insurers are warning lawmakers that time is running out. 

“If things go past the first week of December, it does get much more operationally complicated,” Kris Haltmeyer, the vice president for legislative and regulatory policy at the Blue Cross Blue Shield Association, told me. 

Still, a month into the government shutdown, Congress appears no closer to a deal to extend the extra subsidies that have made marketplace health insurance more affordable since 2021, when Democrats first approved a law that provided significant assistance to pay premiums. 

Republican and Democratic leaders have expressed a desire to find a solution before those subsidies lapse at year’s end. 

But, as is typical with Congress, each party has different ideas about what a deal might look like. And lawmakers haven’t agreed even on how to take a first step. Democrats have demanded an agreement on the ACA subsidies before they will vote to fund the federal government. Republicans, meanwhile, have balked, saying they’ll negotiate only after the government is reopened. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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