Dueling votes to curb health care costs both fail in Congress
The failure of the proposals, one from Democrats and one from Republicans, means lawmakers have little time left to keep costs down for ACA enrollees.
- The enhanced subsidies expire on Dec. 31.
- The Senate voted against extending the subsidies on Dec. 11.
A U.S. Senate vote against extending federal insurance subsidies is set to send Covered California premiums soaring an average of 94% next year for more than 43,000 Ventura County residents, officials said.
The rate hikes may cause 400,000 Californians to drop coverage and go uninsured, said Covered California Executive Director Jessica Altman. If the projection holds up, it could mean more than 9,000 people dropping insurance in Ventura County, creating possible ripple effects that trigger alarms in the health care community.
“They’re going to end up in the ER for their routine care,” said Dr. Neil Canby, an emergency room doctor at Community Memorial Hospital in Ventura, noting delays in seeking care could also make illnesses more severe. “I think we’re going to see an increase in volume and in acuity as well.”
Covered California was one of the marketplaces created across the nation by the Affordable Care Act that was signed into law 15 years ago. It is designed to provide affordable insurance to people not covered by employers and those who have modest incomes but make too much to qualify for Medi-Cal coverage and are too young for Medicare.
The enhanced tax credits were put in place during the COVID-19 pandemic in 2021. The measures increased existing subsidies for lower-income people and created new aid for middle-income people who didn’t previously qualify for the credits.
On Dec. 11, the GOP-controlled Senate rejected a Democratic proposal to extend the subsidies for three years. The Senate also rejected a Republican proposal that would have ended the enhanced subsidies but would have deposited $1,000 to $1,500 into health savings accounts for eligible consumers purchasing plans through the marketplaces.
The vote means the subsidies almost certainly won’t be extended before they expire on Dec. 31. People will start paying higher premiums though Altman retains some hope Congress will ultimately find a solution and the rising prices will be short-lived.
“Nothing is impossible,” she said.
In Ventura County, about 46,830 people received insurance through Covered California as of June. Open enrollment is ongoing and it’s unclear how many people will sign up for coverage in 2026 though Altman said there’s been a statewide drop so far in new clients.
For the more than 43,000 Ventura County residents who receive subsidies, premiums are expected to rise from an average of about $160 a month to more than $300.
Lower income people across the state will receive a reduced subsidy but will still see significant increases in monthly premiums. According to statewide projections from Covered California, a 25-year-old San Bernardino resident making $30,000 could see current monthly rates of $52 rise to more than $170.
‘Caught in the middle ground’
Middle-income members stand to lose their subsidies altogether. Connie Kline, a tax preparer from Simi Valley, said her premiums are set to rise from about $600 a month to $1,100 even though she switched from a plan in the silver tier to a less expensive bronze plan.
“I’m caught in the middle ground. I’m not poor enough to get the help I need, and I’m not rich enough to say it doesn’t matter,” Kline said, noting she considered dropping coverage altogether. “I can’t do that… One little trip to the ER could set me back.”
The increased rates will still be “within reason” for some people, said Mariela Sandoval, a Moorpark insurance agent. But it will mean families have less discretionary income. Some may have to consider cutting down on deposits to college funds for their kids or their own retirement savings.
“I think it’s going to hurt a lot,” she said.
The pending expiration of the subsidies means hospitals will face more uninsured patients and more uncompensated care, said Jonathan Freedman, interim director of the Ventura County Health Care Agency.
The rising premiums come along with federal spending cuts projected to cost the county health system $400 million over six years. County leaders have said the massive cuts could ultimately bring difficult decisions over layoffs, hiring freezes and the possible elimination or reduction of certain services.
Freedman said the specter of soaring Covered California premiums adds to the difficulties. If people drop coverage, it could mean they won’t seek care until their illness worsens and they have no other choice.
Canby of Community Memorial said the hospital anticipates the subsidy changes could mean a 10% increase in emergency room volumes. That will mean longer waits and more people who need to be admitted from the ER into the hospital.
“It’s going to put a burden on the entire system,” he said.
USA Today contributed to this report.
Tom Kisken covers health care and other news for the Ventura County Star. Reach him at [email protected].
SUPPORT LOCAL JOURNALISM: To see more stories like this, subscribe.
