Senator Proposes Two-Year Extension of ACA Premium Subsidies with Fraud Controls

U.S. Senator Jon Husted has introduced the Accountability for Better Care Act, aimed at extending the enhanced Affordable Care Act (ACA) premium subsidies for two more years while imposing new fraud prevention measures. The legislation seeks to address the expiration of enhanced premium tax credits scheduled at the end of 2025, which have been significant in keeping marketplace health insurance premiums affordable and expanding coverage to more than 24 million Americans, including roughly 583,000 Ohioans. This extension would allow Congress additional time to tackle underlying health care cost drivers. Key provisions of Husted's bill include setting a minimum monthly premium of $5 for all enrollees to eliminate zero-premium plans that have been linked to increased fraud risk, expanding subsidy eligibility to households earning up to 600% of the federal poverty level (approximately $192,000 for a family of four), funding cost-sharing reductions starting in 2027 to reduce premiums further, and restricting enhanced premium tax credits to U.S. citizens exclusively. The bill also incorporates Hyde Amendment protections limiting abortion coverage within qualified health plans. This legislation contrasts somewhat with a similar bill introduced by Ohio Senator Bernie Moreno, who proposes a $25 minimum monthly premium with subsidy eligibility capped at $200,000 household income. Both bills eliminate zero-premium plans and extend subsidies but differ in subsidy income limits and coverage conditions. The enhanced ACA subsidies, first introduced under the American Rescue Plan Act of 2021 and extended by the Inflation Reduction Act, have significantly lowered out-of-pocket costs for consumers, preventing a projected doubling of premiums for many if the subsidies expire as scheduled. Analysts warn that expiration could lead to a substantial increase in uninsured individuals nationwide, especially impacting middle-income families above 400% of the federal poverty level due to the reemergence of the "subsidy cliff." Currently, subsidies cap premium contributions at 8.5% of income for all eligible enrollees, but without extension, many will face steep premium hikes. Health care affordability has become a central issue in Husted's re-election campaign, with Democrats highlighting the potential coverage losses tied to subsidy expiration. Husted emphasizes that the legislation aims to improve accountability within health care funding while maintaining affordable premiums, seeking bipartisan support. However, the future of these proposals remains uncertain given the limited legislative calendar and political dynamics in Congress. This legislative effort underscores ongoing policy debates about how to sustain expanded health insurance subsidies and combat fraud while balancing federal budget concerns and health care market stability. It also reflects broader discussions about eligibility criteria and coverage scope under the ACA marketplace framework, with implications for millions of Americans and the insurance industry's regulatory environment going forward.