While the conversation at the House E&C Subcommittee hearing this morning was fairly varied, in the early questioning before the Ways and Means Committee, the debate over the Affordable Care Act has been front and center.
Ranking Member Richard Neal, D-Massachusetts, said in his opening remarks that the expiry of the enhanced subsidies in the reason behind the hearings, and why the affordability of healthcare is front and center in the minds of many.
“When we hear that costs have gone up in the last three months, it’s because the credits have not been extended,” Neal said.
The advanced premium tax credits were put in place as part of the COVID-19 relief response, and expired on Jan. 1. For many individuals enrolled in marketplace plans, this means that their premiums are set to rise significantly if they renew coverage for 2026.
Rep. Adrian Smith, R-Nebraska, said that the tax credits equate to “shoveling government subsidies to paper over a problem.” Before the ACA was instituted, high-risk pools addressed costs related to pre-existing conditions, and Smith said that set-up looks like a “better deal” compared to the current market.
The subsidy debate “really, I think, conceals the problem at hand,” he said.
Smith also expressed concern about improper or fraudulent enrollments on the exchanges. Analyses from the right-leaning Paragon Health Institute suggests that 5 million people may have been improperly enrolled in ACA plans in 2024 alone.
Gail Boudreaux, CEO of Elevance Health, said that the company does share “concern about potential fraud” in the exchanges. However, continuous enrollment plays a key role in ensuring that the insurer can offer critical services to members.
“We think a stable program requires continuous coverage, requires us to be able to deliver preventative care,” she said, “so those are all really important pieces of keeping integrity.”