House Speaker Mike Johnson has declined to call a vote to extend the ACA’s enhanced subsidies, increasing the likelihood that they will expire Dec. 31.
According to a Dec. 17 report by NBC News, Mr. Johnson, a Republican from Louisiana, said the party’s leadership was unable to reach an agreement with Republican House members who were seeking an amendment on a healthcare bill that is set for a vote Dec. 17.
That bill plans to expand access to association health plans by permitting employers — including self-employed workers — to join together to purchase insurance plans. It also includes funding for cost-sharing reduction payments starting in 2027 and would require pharmacy benefit managers to provide employers with detailed data on prescription drug spending, rebates, spread pricing and formulary decisions.
This comes after Senators failed to reach an agreement Dec. 11 over two dueling bills that aimed to address healthcare costs ahead of the Dec. 31 deadline. The vote on advancing the GOP bill was 51-48, with one Republican voting alongside Democrats. The vote on advancing the Democratic bill was also 51-48, with four Republicans joining Democrats to support an extension of the ACA tax credits that are set to expire Dec. 31. Both parties fell short of clearing the 60-vote threshold to overcome the filibuster and pass a bill.
The anticipated price hikes are expected to impact more than 20 million Americans who buy healthcare plans through the ACA marketplace, according to CBS News. ACA premiums have already been on the rise. A recent KFF survey showed most ACA enrollees would consider picking up extra work if healthcare costs were to increase by $1,000 per year. In October, another KFF poll found over 75% of adults supported keeping the credits.
The update comes at a time when healthcare organizations, physicians and ASC leaders “uncertainty around the exchange plans and the Affordable Care Act — what changes are going to occur, how many people are going to become uninsured or underinsured,” Eugenio Hernandez. MD, chief medical officer of Gastro Health, told Becker’s. “That’s less patient volume that we will see.”
Bill Prentice, CEO of the Ambulatory Surgery Center Association, echoed these concerns in an Oct. 10 podcast noting that “[h]ypothetically, if these tax credits went away, you’d see millions of Americans having to pay much more for their health insurance or forgoing health insurance.”
“Millions of Americans not having insurance would have an impact on providers who would otherwise see them as patients,” he added.
The impact of the subsidies’ expiration could have specific impacts on surgical subspecialties, Vamsi Kancherla, MD, of Specialty Orthopedics in Gainesville, Ga., told Becker’s.
“Spine procedures — lumbar fusions, decompressions, cervical fusions, etc. — are classic elective surgeries. Patients experiencing chronic back or neck pain often weigh the benefits against out-of-pocket exposure,” he said. “When premiums rise and deductibles reset in January, many will delay or avoid scheduling these cases to avoid large upfront costs. We’ve seen this pattern historically with insurance disruptions: elective volumes drop as patients prioritize essentials,” adding that he anticipates a 10% to 20% reduction in elective spine case volume in some facilities over the next year.
Adam Bruggeman, CEO and surgeon at Texas Spine Center, told Becker’s that, ideally, a balance could be struck between short term solutions and long term restructuring of the ACA.
“We must ensure that patients are protected through the process while balancing the concerns of fraud, waste, and abuse,” he said. “This is a complex topic due to the political football that is the Affordable Care Act. I think a balance can be had by a short term extension of the tax credits with a gradual elimination of additional credits over time while replacing them with solutions that reduce runaway costs within the system.”
