GOP plans could lead millions to lose health insurance coverage

Nearly 20 million Americans are enrolled in a subsidized health insurance plan through the marketplace created by the Affordable Care Act. If the new Republican-led Congress and President-elect Donald Trump’s administration do not act to renew the subsidies in 2025, many of those subscribers could see their insurance premium payments jump by more than 500%.

The 2017 health care reform law, commonly known as Obamacare, established a marketplace through which individuals can purchase affordable health insurance plans along with subsidies to help lower-income earners afford them. President Joe Biden’s 2021 American Rescue Plan Act and 2022 Inflation Reduction Act included provisions that increased those subsidies through 2025, capping out-of-pocket insurance premiums at no more than 8.5% of a person’s annual income for those making up to 400% of the poverty level. This expansion helped middle-income families buy insurance policies. 

Trump said in the Sept. 10 presidential debate that he may again try to repeal and replace the ACA with “something better and less expensive.” As in his 2016 campaign, he offered no details, this time saying, “I have concepts of a plan.” 

The Republican Study Committee, a conservative caucus that includes most of the GOP lawmakers in the U.S. House of Representatives, called in its 2025 budget proposal for the elimination of what it called “Obamacare subsidies for the wealthy, which were extended by the Inflation Reduction Act.” Idaho Republican U.S. Sen. Mike Crapo, the top Republican on the Senate Finance Committee, said in September that he does not support extending the subsidies and that “Instead of perpetuating a tax-and-spend agenda, we can and should work together to improve health-care choice, affordability and reliability.”

The nonpartisan Congressional Budget Office predicted in July that 22.8 million Americans will obtain insurance through the marketplace in 2025, but that this number will drop to 18.9 million in 2026 and to 15.8 million in 2028 unless the subsidies are renewed. That would represent a decline of 31%.

According to KFF data, 117,882 Nebraskans selected a 2024 insurance plan through the Obamacare marketplace.

A nearly one-third reduction like the CBO predicted would mean more than 36,000 people in the state would lose their insurance coverage.

In 2017, Nebraska Republican Reps. Don Bacon and Adrian Smith voted for Trump’s American Health Care Act, which would have repealed the Affordable Care Act and increased the number of Americans without health insurance coverage by an estimated 23 million. Republican Deb Fischer voted for a similar plan in the Senate. 

Every Republican in Congress voted against the 2021 and 2022 laws that increased the subsidies.