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Millions of Americans who buy health insurance through the Affordable Care Act (ACA) exchange — including many in Ohio, Kentucky, and Indiana — are living on pins and needles as this federal government shutdown grinds on with no end in sight.
These are individuals and families who depend on ACA tax subsidies to be able to afford health care coverage, and who will lose that help at the end of this year if Congress does not end the stalemate soon.
Democrats in Congress say there is one man who could end it with a phone call to the Republican leaders of the House and Senate.
That man is Donald Trump.
And there is no sign yet that he is going to permit majority Republicans in Congress to work out a deal with Democrats to save their constituents from either being priced out of health care coverage or seeing their premiums double.
“He seems to blow hot and cold on this,” said Rep. Greg Landsman, a Cincinnati Democrat. “This ends when the president tells Republicans that they are going to be on the wrong end of an 80-20 issue and that they should negotiate. But that hasn’t happened yet.
“Donald Trump has all the power on this,” Landsman said.
A recent national poll conducted for KFF (formerly the Kaiser Family Foundation) showed 78% of Americans support extending ACA subsides. And that support is across the political spectrum — Democrats (92%), independents (82%), and Republicans (59%). Even a majority of those who identify as MAGA supporters (57%) favor keeping the ACA subsidies.
Landsman said in his district alone — which takes in all of Cincinnati and Warren County — 32,000 of his constituents will feel the impact of losing ACA subsidies; and, according to KFF numbers, as many as 14,000 of them will end up losing their health care coverage because they can no longer afford it.
A spokeswoman for Ohio’s junior senator, Republican Jon Husted, offered a written statement that will likely be cold comfort to Democrats looking to break the stalemate.
“Senator Husted continues to vote to reopen the government through a clean, bipartisan extension of funding. He has said that he looks forward to having conversations with Democrats about lowering health care costs for working families and reforming the system to remove waste, fraud, and abuse, but not while services that Ohioans rely on are halted and troops may not get their next paycheck,” she said.
The ACA subsidies, which are tax credits, grew out of the 2010 passage of the Affordable Care Act (also often called Obamacare) which set health care marketplaces for people who had no access to employer-based health insurance or were not eligible for Medicare or Medicaid.
The people taking advantage of the ACA system are people like real estate brokers, farmers, barbers — anyone who is self-employed. There are many people, too, who retire at the age of 60, lose their employer’s insurance, and have to cover the gap until they are 65 and can qualify for Medicare.
Now, the people who use ACA subsidies to pay for health care are already getting letters in the mail warning them the subsidies may be going away soon.
What's more, people getting ACA subsidies may soon be in for a “double whammy” that will effect all Ohioans with health insurance, according to a leading health care policy analyst.
Brian O'Rourke, policy analyst for the Health Policy Institute of Ohio, said insurance companies operating in Ohio already are proposing plans to state regulators that have the highest rate increases since 2017.
“The fear is that higher premiums and no ACA subsidies will just drive many people out of the system altogether,’’ O’Rourke said.
Healthy people in their 20s and 30s may decide to go without insurance, O’Rourke said.
“That could be disastrous,” O’Rourke said. “Yes, you may be healthy today, but what if something catastrophic occurs and you end up needing long-term care?
“And when people drop their insurance coverage, they’re not getting routine check-ups, not getting the testing that can spot serious medical problems that need to be treated right away,” he said.
Health care in Ohio already is expensive enough without ending ACA subsidies and cuts to Medicaid, O’Rourke said.
Numbers compiled by United Way showed that a family of four — two adults, two children — need to earn $79,224 to afford basic health care needs. According to the Health Policy Institute of Ohio, families in Ohio spent considerably more than the national average in out-of-pocket medical expenses in 2023: $2,680 compared to $1,900 nationwide.
“The situation is bad enough, but the government shutdown is causing a big problem,” O’Rourke said. “The politics of it just complicates things even more.”
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