Millones de estadounidenses inscritos en planes de seguro médico de la Ley de Cuidado de Salud Asequible (conocida comúnmente como seguro Obamacare) se enfrentan a la perspectiva de gastos mucho más elevados el próximo año sin que se vislumbre un alivio garantizado.
El Senado votó el 9 de noviembre un acuerdo bipartidista entre algunos demócratas, republicanos y la Casa Blanca del presidente Donald Trump que reabriría completamente el gobierno hasta el 30 de enero. El acuerdo pondría fin al cierre del gobierno federal más largo sin una garantía de extender los subsidios de la era de la pandemia de COVID-19 que hicieron que los planes de Obamacare fueran menos costosos para millones de estadounidenses.
Según el acuerdo bipartidista, el Congreso acordó votar en diciembre la extensión de los subsidios. Los expertos señalaron que la incertidumbre y la preocupación por la asequibilidad probablemente lleven a algunos consumidores, más preocupados por los costos y con mejor salud, a renunciar a la cobertura de la Ley de Cuidado de la Salud a Bajo Precio (ACA).
“Desafortunadamente, este acuerdo prolongará la incertidumbre para millones de estadounidenses que obtienen su seguro médico a través de la Ley de Cuidado de Salud Asequible”, dijo Sabrina Corlette, codirectora del Centro de Reformas de Seguros de Salud de la Universidad de Georgetown. “El Congreso prácticamente garantiza que los mercados perderán inscritos a las personas que se desea conservar: los jóvenes y las personas sanas”.
Según estimaciones de KFF, 22 millones de estadounidenses que reciben subsidios de la ACA verán que sus primas mensuales aumentan más del doble en promedio. Esto no significa que el precio de estos planes de la ACA se duplique, pero sin los subsidios adicionales, los consumidores pagarán un promedio de $1,016 más en 2026. El monto final que pagarán dependerá de su edad, ingresos, lugar de residencia y nivel de cobertura.
¿Por qué los consumidores se enfrentan a seguros de salud más caros en virtud de la Ley de Asistencia Asequible (Affordable Care Act)?
Hasta que se conoció el acuerdo del domingo, los demócratas del Congreso se habían negado a aprobar un acuerdo de gasto federal que no extendiera los subsidios de la ACA de la era de la pandemia.
If Congress approves the bipartisan deal, the insurance subsidies will revert to original levels of the Affordable Care Act. Under President Barack Obama’s signature 2010 health care law, cost-saving tax credits were limited to those who earn up to four times the federal poverty level.
Congress temporarily approved more generous subsidies during the COVID-19 pandemic to ensure more Americans could afford health coverage. The United States declared the COVID-19 public health emergency ended in 2023, and the enhanced ACA subsidies are set to expire at the end of 2025.
With the pandemic-era subsidies ending, those who earn more than four times the federal poverty level must pay the full cost of their ACA plans. Lower-income Americans will still qualify for the Obama-era subsidies, but they won’t get the COVID-era subsidies that sharply reduced their out-of-pocket costs.
¿Cuánto aumentarán los costos del seguro para los inscritos en la ACA?
Health insurance companies typically raise rates based on the underlying cost of medical care and how often consumers get care from a doctor, hospital or fill prescriptions.
Insurers who sell plans on the ACA federal and state marketplaces are raising rates an average of 26% for 2026 plans, according to an analysis by KFF, a health policy nonprofit.
But the amount most ACA consumers pay out of pocket will increase at a faster rate with the pandemic subsidies expiring.
Those who earn more than four times the federal poverty level − $62,600 for an individual or $128,600 for a family of four − will have to pay the full amount. Those who earn less than four times the poverty level will get less financial help. In other words, they will get the original Obama-era subsidies based on a sliding scale share of their income.
¿Qué pasará con los consumidores a quienes se les pedirá que paguen más?
Consumers will have the option of switching to ACA plans that provide less generous benefits. An enrollees in a «silver» plan might choose a bronze plan that charges lower monthly premium but higher deductibles – the amount consumers must pay before coverage kicks in.
As many as 4.2 million Americans would drop ACA coverage due to the expiration of the pandemic-era credits, according to a June estimate by the nonpartisan Congressional Budget Office. Yet if the pandemic-era subsidies are extended, more than 3.4 million Americans would gain coverage each year through 2034, the CBO said.
Entrepreneurs who don’t have access to employer health insurance are among those who would suffer if the pandemic tax credits expire, according to the nonprofit Small Business Majority.
“An agreement that would reopen the federal government without renewing the Affordable Care Act’s enhanced premium tax credits deals a huge blow to the fortunes of small businesses in America,» said John Arensmeyer, the small business group’s founder and CEO.
Others who might face higher insurance bills include farmers and gig economy workers who don’t get coverage through the workplace, Corlette said.
Without the pandemic-era subsidies, ACA health insurers could face the prospect of serving a larger share of high-cost enrollees, Corlette said.
«We could be in for a stretch where insurance companies have to raise their premiums again to reflect a smaller and sicker market,» Corlette said. «So 2027 premiums are likely to be even higher, and some insurance companies may decide this is not a market they want to continue being in.»