When the Affordable Care Act subsidies end next week, nearly 300,000 people in Massachusetts and 400,000 in Pennsylvania could see their premiums skyrocket. In Georgia, the number affected will be up around 1.3 million.
This is why it doesn’t go far enough to say 22 million people will see a dramatic increase in the cost of healthcare next week, without looking at how concentrated the effect is going to be in a few states.
It looked like crafty manipulation of the political calendar when the One Big Beautiful Bill Act scheduled the heaviest cuts in Medicaid to begin after the midterm elections. But this has resulted in the earliest and possibly the most politically costly impact of the budget bill falling on the 10 states, all Republican and mostly in the South, which didn’t accept the ACA Medicaid expansion.
These are the states that have seen the biggest increase in people using the subsidies since they were legislated during the pandemic, people who, in other states, might have been covered under the Medicaid expansion. In addition to Georgia, those states are Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
The state projected to be the most affected is Florida, where roughly 20 percent of the population, about 4.7 million, receive subsidies. But the impact in Georgia will be nearly as great.
A very high percentage of the people who are insured through ACA plans either work for or own small businesses. They are the very people you see held up in every election campaign as the lifeblood of the economy. The ripple effect, when these people look at healthcare cost increases in the thousands over the next year, could be very severe.
With all this in mind, the question might naturally arise: how did things get to this point? Congress has so often saved itself with a late jolt of political practicality, or expediency, that in the closing days before it adjourned for the year, a last-minute deal to extend the subsidies seemed possible. But a top-down Republican determination to make a clean break with the ACA proved the stronger force in votes last week.
So with the midterm elections already looking ominous, Republicans representing the states that will absorb the greatest share of the pain from the termination of the subsidies stayed in line, rejecting a Democratic proposal to extend the subsidies in the Senate, and passing a healthcare bill without the subsidies in the House.
Democrats have held out hope for some kind of retroactive extension, and maybe the outcry next week will be great enough to bring about something like that. Likely not, however. The debate over affordability is about to reach a new pitch, especially in states like Georgia.
