Indeed, the temporary subsidies for people who buy their coverage through the Affordable Care Act exchanges – the aid that was provided as part of the year’s massive covid-19 relief package. latest – set to expire at the end of 2022. Stalled BBB legislation would provide an extension of subsidies.

The exchanges were set up for people who do not receive health insurance through work or government programs such as Medicare and Medicaid. They include pre-retirees, gig workers and other self-employed people, as well as people employed by small businesses that don’t offer group coverage. In its original version, the Health Care Act 2010 provided premium support only for households earning between 100% and 400% of the poverty line.

In 2021, the American Rescue Plan Act made temporary premium assistance available to about 3.7 million more people, most with incomes between four and six times the poverty level, according to the Kaiser Family Foundation. . This new help for those whose incomes were previously too high to qualify for help is a key reason a record 14.5 million Americans signed up for health coverage this year through the Obamacare markets, surpassing the previous peak by nearly 2 million.

What benefit did people receive from these grants? Again, some numbers from Kaiser: they’re enough to cover more than half of the $11,000 annual premium for a relatively low-deductible “silver” plan for a 60-year-old earning just over $51,000, or about four times the poverty line. Without the aid, the monthly premium paid this year by a couple over 50 earning $75,000 would increase by nearly $700, bringing the total cost of their plan to more than $1,200 a month.

The loss of these subsidies would therefore be a blow for people who earn a living but who are far from being rich. And that’s not all they’re likely to face when the annual Obamacare exchange sign-up rolls around. Since hospitals pay much higher labor and other costs, insurance premiums are expected to rise by double digits next year.

This kind of sticker shock will force many people to buy plans with lower coverage or higher deductibles and other out-of-pocket expenses. They could be totally excluded from the health insurance market.

All of this should add some urgency to the seemingly moribund negotiations between the White House and Democrats on Capitol Hill to determine which parts of the president’s original multi-trillion-dollar proposal to transform the US economy could still be salvaged. (The Congressional Budget Office estimates that extending temporary subsidies to people who buy insurance on health care exchanges would cost about $210 billion over the next decade.)

Time is running out and Democrats may not get a second chance if they miss this opportunity. Republicans, if they take control of one or both chambers after elections this fall, are unlikely to support the ACA, which they hate. “Members of Congress — especially Democrats — aren’t acting like it’s a crisis. They can fix this,” Chris Jennings, who was a top health care adviser to the US, told me. Clinton and Obama administrations.

Extending the grants would require a simple majority under the Senate budget reconciliation rules. Frustrated and opaque Sen. Joe Manchin III (DW.Va.) remains the crucial vote, but there’s reason to believe he wouldn’t be an obstacle. He has been a supporter of the Affordable Care Act and has generally expressed openness to measures that would reduce health care costs, including allowing Medicare to negotiate prescription drug prices, which is another provision of the Biden agenda and something Democrats have promised for many years. .

Democrats, even with their narrow House and Senate majorities, can still cross the finish line. Preventing an entirely predictable explosion in health care costs should be part of that.