It now seems nearly inevitable that health insurance costs will spike at the end of the month for nearly 600,000 Ohioans and 23 million Americans. An Ohio family doctor and colleagues in other states are blasting Republicans in Congress for not doing more to stop it.
Subsidies for health care purchased on exchanges created under the Affordable Care Act are set to expire Jan. 1, causing health expenses to more than double for millions.
“Without the ACA tax credits, they just can’t make health care work in their budget. So they’ll put off screenings… they won’t just split pills, they won’t take them at all,” said Catherine Romanos, a Columbus family doctor.
She was speaking during a virtual press conference last week sponsored by the Committee to Protect Health Care, a nonprofit advocacy group of 36,000 doctors that says it doesn’t accept funding from for-profit health care corporations.
“I don’t blame them,” Romanos said of her patients. “Everything is expensive — rent, child care, groceries. Something has to give. I blame the leaders in Washington. They had an opportunity to help out patients like the ones I see every day. They had an opportunity to ensure that their constituents would continue seeing the doctor… but they chose not to.”
The office of Ohio Republican U.S. Sen. Bernie Moreno attacked Romanos on political grounds and said he was working on a compromise extension of the subsidies. The office of Ohio Republican U.S. Sen. Jon Husted did not respond to a request for comment.
Despite President Donald Trump’s promises to quickly stop inflation, it continues nearly a year into his second term.
Meanwhile, when adjusted for inflation, median annual income actually dropped from about $71,000 in 2019 to $67,873 four years later, according to the Ohio Housing Finance Agency.
Even so, Husted and Moreno this summer voted for Trump’s One Big Beautiful Bill Act. It extended Trump’s 2017 tax cuts, at a cost of $4 trillion over 10 years, with $1 trillion of that benefit flowing to the richest 1% of Americans. It will add an estimated $3.4 trillion to the deficit.
At the same time, it cuts more than $1 trillion in medical and food assistance to low-income Americans over the same period. Even though they extended the tax cuts, congressional Republicans opted not to extend 2021 subsidies to people buying health insurance on the ACA exchanges.
The struggle over the subsidies was at the center of a 43-day government shutdown that ended Nov. 12. Husted said he didn’t want to put the $350 billion cost to extend them 10 years “on the national credit card for a program that we know is dysfunctional.”
Those subsidies average about $700 a year, but they can be as high as $20,000 for some. They’re credited with helping to bring the rate of uninsured Americans to an all-time low.
Republicans have thus far thwarted Democratic attempts to renew the subsidies, but huge majorities of Americans support doing so. Vulnerable Republicans in Congress have defied their leaders and joined an effort to force a vote on an extension sometime in January.
Moreno has been participating in bipartisan talks about a compromise. And he and Sen. Susan Collins, R-Maine, in December made a proposal for a two-year extension that didn’t go anywhere.
If an agreement is struck in January, it can be made retroactive. But by then, the damage will already be piling up.
The health-analysis nonprofit KFF estimates that average premiums for 23 million Americans will more than double in the absence of the subsidies. And nearly 5 million are expected to drop coverage and join the ranks of the uninsured.
The time to have extended the subsidies was months ago, before the government shutdown, Rob Davidson said. He’s an emergency doctor in western Michigan who spoke during the Committee to Protect Health Care press conference.
“This didn’t sneak up on us,” he said. “Democrats and health care advocates have been calling for months — pretty much all year — for Congress to take action and extend the ACA tax credits, but congressional Republicans have chosen to do nothing.”
He said the expiration of the subsidies would hurt everybody.
Emergency doctors in Ohio have said that just because people lose insurance, that doesn’t mean they’ll stop getting sick. And emergency departments have to treat them regardless of their ability to pay.
That will sap hospital budgets and increase wait times and compromise care for all, they said.
“This isn’t just a crisis for Americans who get their health care through the ACA,” Davidson said. “When millions of Americans can no longer afford their plans, and when millions more lose their health care because of Republican cuts to Medicaid, hospitals operating on thin margins will be forced to close.”
Romanos, the Columbus family doctor, said patients themselves will become sicker if skyrocketing premiums make them poorer. The vast majority of those receiving subsidies already are in the bottom half of the income distribution.
About 70% of the people using the ACA exchanges make 250% or less of the federal poverty guidelines. For a family of four, that’s $80,375 a year, or a third less than the median income for a family of that size in Ohio.
Romanos said patients will ration their own care if they think they can’t afford it.
“Maybe they don’t get all the lab tests that I want, or they don’t take all the medicine I prescribe,” she said. “Some just can’t afford the health care I recommend.”
She said it all could have been prevented months ago.
“Here in Ohio, our senators, Jon Husted and Bernie Moreno, voted against helping Ohioans afford health insurance,” Romanos said.
“They voted to let premiums skyrocket. Earlier this year, senators Moreno and Husted voted to give tax breaks to billionaires, but I guess health care for working families is just too expensive. What a slap in the face for my patients. Ohioans deserve leaders who look out for them, not billionaires like Donald Trump, who mocks affordability.”
Reagan McCarthy, Moreno’s communications director, responded with a statement focused on politics instead of the ACA subsidies.
“Catherine Romanos is a progressive activist and longtime Democrat donor who supported (former Democratic Vice President) Kamala Harris (and former Democratic Ohio Sen.) Sherrod Brown,” McCarthy said in an email.
“Romanos even served as a surrogate for the Ohio Democrat(ic) Party and falsely attacked Senator Moreno repeatedly. Someone who ‘fell in love with the idea of being an abortion provider’ is hardly an objective source for this garbage ‘journalism.’ Once again, the Ohio Capital Journal chooses to shamelessly prop up Ohio Democrats rather than report the facts.”
Husted’s office didn’t respond to a request for comment.
After the government shutdown ended in November, Husted proposed a “freeze” that would have extended the subsidies while cutting benefits, the number of people who could get them or both.
Makunda Abdul-Mbacke is an OB-GYN in Rockingham County, a rural area in the North Carolina Piedmont. She said taking away the ACA subsidies and slashing Medicaid spending will drive many already-struggling rural hospitals out of business, and that will force struggling patients to drive farther for preventative care, such as Pap smears and mammograms.
“Without a mammogram, we will not be able to pick up breast cancer when it’s early,” Abdul-Mbacke said.
“We will pick it up when it’s stage three or stage four and that means that someone is losing their mother. Someone is losing their aunt or their sister or their daughter. It just appears as though the Republicans we elected just don’t care about those things as long as it’s not their family.”
This story was originally published by the Ohio Capital Journal and republished here with permission.