With the ACA’s subsidies set to expire in 2025, millions of Americans will lose their health insurance.

Even the Republic is moving forward close to gaining control of Congress, millions of Americans could be at risk of losing improved subsidies that currently underwrite the cost of health insurance purchased through the Affordable Care Act’s marketplaces, according to industry experts and the Congressional Budget Office.

The November 5 elections handed control of the Senate to Republicans, while control of the House remained in limbo on Monday as votes in several critical races continued to be counted. Currently, Democrats are expected to win at least 210 House seats and Republicans 215, with the party needing 218 seats to secure a majority.

If Republicans gain control of Congress, it is widely expected to allow enhanced ACA subsidies to expire at the end of 2025, preventing many people who purchase coverage through the ACA and who currently receive these subsidies, from follow a health care plan. experts.

The so-called reformed Affordable Care Act (ACA), which lowers the cost of health plans for millions of Americans and was passed under the Biden administration, will expire unless lawmakers renew them. During his first term in office, President-elect Donald Trump supported efforts by Republican lawmakers to repeal the ACA, but he has yet to reveal his plans for the program, known as Obamacare, for his second term in office.

Republican House Speaker Mike Johnson said during a campaign stop last week ahead of the Nov. 5 that “ACA is ingrained, we need a big change to make this work, and we have a lot of ideas on how to do it. that.”

Who is eligible for the ACA’s enhanced subsidies?

Americans with incomes over 400% of the poverty level — those who make more than four times the poverty level, or $103,280 for a family of four — are eligible for the ACA’s enhanced insurance subsidies. They also increased financial assistance for those who were already eligible for assistance under the ACA.

KFF, an independent not-for-profit life insurance policy, estimates that the subsidies have reduced premiums for eligible individuals by 44%, or $705 annually. The organization says that if the tax credit ends, the average enrollment rates in 12 states could at least double.

In 2024, of the 21.6 million Americans who purchased health insurance plans in the ACA marketplaces, 20.1 million received improved subsidies, according to the CBO..

The people most at risk of losing ACA coverage if enhanced subsidies end are those who live in areas where health insurance premiums are very high, including rural areas for low-income families middle Americans who rely on enhanced subsidies, could see a sharp increase in funding. Cynthia Cox, vice president and ACA policy researcher at KFF, told CBS MoneyWatch.

“They can go from paying no more than 8.5% of their income to easily paying 20% ​​or more,” he said. “I think a lot of those people will stop reporting.”

In addition to improving subsidies, many ACA Marketplace enrollees who earn more than four times their income will be cut back on health insurance, according to Cox.

Support is still available for 2025

Louise Norris, a health policy analyst at healthinsurance.org, noted that 93% of people who purchase health insurance through the ACA marketplaces receive improved subsidies. A sharp increase in their premiums could cause many to drop out and become uninsured, he said.

CBO estimates that 22.8 million Americans will enroll in ACA marketplace health insurance plans by 2025. The agency expects enrollment to drop significantly, from 22.8 million to 18.9 million, by 2026 if the subsidies are not renewed. By 2030, enrollment could drop to 15.4 million people without improved subsidies.

Currently, the grant reforms will remain in place until the end of 2025.

“If people sign up now during open enrollment, their coverage will start in January, and it will cover them for the whole year. Their rates will not change – they are good for 2025,” Norris said. said.

The revised grants, which were first passed in 2021 as part of the Saving America Act, will be in place for about five years when they expire in 2025, or about half as long as the ACA market remains in place, Cox said.

Enrollment in ACA plans has nearly doubled since the subsidies went into effect, he noted, and much of that growth has come from low-income enrollees. “That’s one group you can expect to see, if they have to start making higher payments, they’re going to lower their coverage,” he said.

Making the revised subsidies permanent would cost $335 billion over 10 years, according to the CBO.