Five things to know about the renewal of the Affordable Care Act’s Inflation Reduction Act grants

As part of the Inflation Reduction Act, the Senate recently approved a three-year extension (through 2025) of enhanced subsidies for people who buy their own health coverage in the Care Act’s Marketplaces affordable These temporary grants were originally slated to last for two years (2021 and 2022) and were approved as part of the American Rescue Plan Act (ARPA). Enhanced subsidies increase the amount of financial aid available to those who were already eligible, and also recently expanded subsidies to middle-income people, many of whom were previously priced out of coverage.

Here’s what you need to know about the likely renewal of these grants:

If signed into law, the Inflation Reduction Act will prevent sharp increases in market premium payments

If Congress extends the temporary subsidies, as seems likely, premium payments in 2023 will remain mostly flat for enrollees in the marketplace, as premium tax credits protect enrollees from underlying premium increases. Passage of the Inflation Reduction Act will extend the temporary subsidies, preventing out-of-pocket premium payments from rising across the board next year for virtually all 13 million subsidized enrollees. In the 33 states that use, premium payments in 2022 would have been 53% higher (more than $700 more per year) on average if not for these enhanced subsidies. The same goes for states that operate their own exchanges. The exact amount of premium increase enrollees would have seen in the absence of the Inflation Reduction Act would have depended on the enrollee’s income, age and premiums where they live.

For example, using our subsidy calculator, you can see that with ARPA a 40-year-old couple earning $25,000 a year currently pays $0 for a silver plan premium with significantly reduced out-of-pocket costs. This would continue to be true under the Inflation Reduction Act, which continues ARPA grants without interruption for three more years. Using a new version of our subsidy calculator which shows what premium payments would have been in each postcode if ARPA had no past, you can see that the same couple would have paid $76 a month (or $915 throughout 2022) without ARPA. Under the Inflation Reduction Act, however, this low-income couple would save $915 a year.

Here’s another example with the new calculator: In the absence of these enhanced subsidies, a 60-year-old couple with an income of $70,000 would have had to pay $1,859 a month (or $22,307 in 2022) for full price. silver plan Now compare that to our 2022 calculator showing what they currently pay under ARPA: The same couple currently pays $496 a month (or $5,950 over the year) and would continue to pay a similar amount based on the Inflation reduction law. . Instead of expecting her to pay about 32% of her income for insurance, which would likely be unaffordable, the couple pays 8.5% of her income with enhanced subsidies. So, if Congress passes the Inflation Reduction Act, this middle-aged couple will save more than $16,000 a year.

Related: See how 2022 premium payments would rise without enhanced tax credits from ARPA’s COVID-19 relief law. Click on the images below to access two versions of the calculator.

The Double Whammy: How 2023 premium increases and subsidy expirations would have affected some enrollees

The Inflation Reduction Act’s renewal of these enhanced subsidies would also prevent some enrollees from experiencing two types of premium increases at the same time. If Congress had allowed the enhanced subsidies to expire, the subsidy cliff would have returned, meaning people with incomes above four times the poverty level (or about $51,520 for a single person) would lose the subsidy entirely subsidy eligibility. So, without the Inflation Reduction Act, these members would not only pay the increase for the loss of subsidies, but also any increase in the underlying premium.

Our first look at 2023 premiums shows premiums rising around 10%, with most rate increases falling between 5% and 14%. This is more than in recent years, partly due to inflation and recovery in utilization. These rates are still being proposed and will be finalized this month.

The figure below shows a hypothetical subsidy cliff if premiums actually increase by 10%. For example, a 60-year-old earning just over four times the poverty level ($51,521) in 2022 pays 8.5% of her income in a silver plan with enhanced subsidies, but would have paid 22% of her income in 2022 without these subsidies on average. in the US If it weren’t for the Inflation Reduction Act and if premiums increase 10% in 2023, this person would pay 24% of their income in 2023.

In states where premiums are currently highest, people losing subsidies would have seen the sharpest increases without the Inflation Reduction Act’s continuation of these enhanced subsidies. For example, a 60-year-old earning just over four times the poverty level ($51,521) in 2022 would have paid more than a third of his income into an unsubsidized silver plan in West Virginia and Wyoming; and in New Hampshire, the individual would have paid 15% of their unsubsidized income.

The Clock: Why Time Matters

The timing of the Inflation Reduction Act is important for insurers, regulators, and state and federal marketplace administrators. Insurers are now in the process of finalizing premiums for 2023, and some are already considering an additional premium increase as they wait for ARPA grants to expire.

The National Association of Insurance Commissioners (NAIC) wrote to Congress asking that these subsidies be extended in July to provide greater certainty as insurers set premiums for the coming year.

States and the federal government, which operates, will have to reprogram their enrollment websites and train consumer assistance staff about the policy changes months before open enrollment this fall.

The end of the public health emergency: How enhanced market subsidies could mitigate the loss of coverage

The end of the public health emergency, and with it the continued Medicaid enrollment requirement, is expected to result in significant coverage losses. So far, the number of people without insurance has not grown during the pandemic and the ensuing economic crisis. However, ironically, we could see a jump in the uninsured rate as the public health emergency ends if people opting out of Medicaid can’t find alternative coverage.

With the passage of the Inflation Reduction Act, enhanced Marketplace subsidies could act as a bridge between Medicaid and the ACA’s marketplaces when the public health emergency ends. If enhanced Marketplace subsidies are still in place when Medicaid maintenance of eligibility (MOE) ends, many people who opt out of Medicaid could find similar low-cost coverage in the ACA marketplaces. If eligible for Marketplace subsidies, people who lose Medicaid coverage can find Marketplace plans that, like Medicaid, have a zero (or nearly zero) monthly premium requirement.

The costs: What this means for the federal budget

Although the Congressional Budget Office (CBO) has not yet released a final score for the Inflation Reduction Act, an initial CBO estimate pegged the cost of a permanent extension of the enhanced allowances at about 25,000 million dollars annually. The Inflation Reduction Act extends these subsidies for three years (through 2025), not permanently, although the average annual cost is likely to be similar. Much of the estimated cost is due to the CBO’s expectation that millions more people would enroll in the ACA marketplaces than if the enhanced subsidies were not extended. The actual cost will depend on how many people sign up and how much premiums rise over the next few years.


Healthcare inflation, increased utilization and other factors may cause premiums in 2023 to rise more than in recent years. However, as we’ve written before, Congressional action to extend ARPA subsidies through the Inflation Reduction Act will have an even greater influence on how much ACA Marketplace enrollees pay out of pocket for your premiums than the market-driven factors that affect the underlying premium.

Whether the subsidies expire at the end of this year or in two or three years, their expiration would result in the steepest increase in out-of-pocket premium payments that most enrollees in this market have seen. Because the Inflation Reduction Act extends the enhanced subsidies for three years and not permanently, futures enrollees in the marketplace may see steep premium increases when the subsidies eventually expire.

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