Growing number of local residents depend on ACA subsidies

A growing number of Bartholomew County residents have been receiving the federal health insurance subsidies that are at the center of the government shutdown that has dragged on for more than two weeks.

This year, 3,516 Bartholomew County residents received the subsidies under the Affordable Care Act (ACA) — about 4% of the county's population — according to the U.S. Centers for Medicare and Medicaid, which tracks enrollment through the ACA.

By comparison, that is more than double the 1,671 local residents who received the subsidies in 2023 and up from 942 residents in 2021. The average subsidy this year among Bartholomew County residents was $401 per month.

The subsidies go to low- and middle-income people who purchase health insurance through the ACA and do not receive coverage through an employer, Medicare or Medicaid, The Associated Press reported.

The amount of financial assistance available to people buying coverage through the ACA was increased in 2021 under President Joe Biden through the American Rescue Plan Act. The following year, the Inflation Reduction Act extended the expanded assistance through the end of 2025.

Since the expansion, enrollment in the health insurance through the ACA has more than doubled nationwide — and nearly quadrupled in Bartholomew County.

Without congressional action, the additional help will expire at the end of the year, according to wire reports. Their expiration would more than double what subsidized enrollees currently pay for premiums next year, according to an analysis by KFF, a nonprofit that researches health care issues.

For instance, a family of four in Bartholomew County with a household income of $60,000 would see premiums increase by $225 per month next year to insure a married couple without the expanded subsidies, according to a calculator by KFF.

"There are so many needs out there. We want to fund school lunches. We want to fund affordable housing. We want safe, clean air. …The question is should we spend as we did (during the pandemic)? Or is there a different way to use the money?" said Kosali Simon, a distinguished professor at the Paul H. O'Neill School of Public and Environmental Affairs at Indiana University. "…People might say … we should keep spending because since (2021), when we started giving out a lot more government money for free or subsidized health insurance, people didn't have to pay and so there were fewer people uninsured. And if we don't put all that extra money in, then, of course, there will be more people uninsured. So, that's the trade off. It's a tough thing for society. I don't think there are any easy answers."

At the same time, local non-profits, including Love Chapel, have expressed concern that reducing health care subsidies could drive up demand for their services.

Love Chapel operates a food pantry in Columbus and provides assistance for those needing help with rent and utilities.

"People are already struggling," said Love Chapel Executive Director Kelly Daugherty. "That's bound to cause an increased demand for our services."

"Whether it be housing costs going up or subsidies for health insurance going away or cuts in SNAP benefits, it just puts a squeeze on a family's budget and it's going to show up somewhere, whether it's utilities, whether it's food or rent," Daugherty added. "…It all works together, and whenever there's a cut, it just hurts those people that much more."

At the national level, Democrats are seeking negotiations on the subsidies, while Republicans say they won't discuss it, or any other policy, until the government reopens, according to wire reports.

The two sides are also offering starkly different visions of the Affordable Care Act and how to deal with the expanded premium assistance that will soon expire for millions of people — Democrats want the aid extended, while Republicans insist the subsidized health care system is broken and must be cut back.

"Democrats' position has not changed," said Senate Democratic Leader Chuck Schumer. "We want the same thing that a majority, an overwhelming majority, of Americans want, which is to end this shutdown and halt the health care crisis that will send premiums spiking for tens of millions of people."

It's unclear how the impasse will end, even as hundreds of thousands of federal workers are going unpaid and many government services are slowed or suspended, according to the AP. Democrats believe the public is on their side as they fight to keep the COVID-era subsidies, but health care is also one of the most intractable issues in Congress — and a real compromise is unlikely to be easy, or quick.

There are some Republicans in Congress who want to extend the aid as millions of people who receive their insurance through the ACA marketplaces are set to receive notices that their premiums will increase at the beginning of the year. But many GOP lawmakers are strongly opposed to any extension — and see the debate as a new opportunity to try to reform the program.

Republicans have been railing against the Affordable Care Act, former President Barack Obama's signature health care law, since it was enacted 15 years ago, according to wire reports. But while they have been able to chip away at it, they have not been able to substantially alter it as a record 24 million people are now signed up for insurance coverage through the ACA, in large part because billions of dollars in subsidies have made the plans more affordable for many people.

Now, some of them see the Democrats' fight as their chance to revisit the issue — putting Republican congressional leaders and President Donald Trump in a complicated position.

The Senate has now rejected a House-passed bill to extend government funding until mid-November five times, with Democrats denying Republicans the votes to pass it unless they win concessions on health care.

With leaders at odds, some rank-and-file senators in both parties have been in private talks to try to find a way out of the shutdown, according to wire reports. Republican Sen. Mike Rounds of South Dakota has suggested extending the subsidies for a year and then phasing them out. Senate Appropriations Committee Chairwoman Susan Collins, R-Maine, has suggested pushing ahead with a group of bipartisan spending bills that are pending and then securing a commitment to discuss the health care issue.

But many Democrats say a commitment isn't good enough, and Republicans say they need deeper reforms — leaving the talks, and the U.S. government, at a standstill.

Maine Sen. Angus King, an independent who caucuses with Democrats, voted with Republicans to keep the government open. But he said Monday that he might switch his vote to "no" if Republicans do not "offer some real solid evidence that they are going to help us with this crisis" on health care.

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