Manchin reluctant to add ACA subsidy extension to narrow spending deal

A key senator would not commit to extending enhanced subsidies for Affordable Care Act (ACA) plans as part of a larger spending package, throwing the prospects for an extension into limbo.

Sen. Joe Manchin, D-West Virginia, said he is apprehensive about adding ACA enhanced subsidies to a narrow spending package that is expected to include a deal on prescription drug pricing reforms. The remarks to Fierce Healthcare come as the enhanced subsidies—which helped spark record-level enrollment—are going to expire after this year unless Congress acts. 

“I am just concerned about inflation right now. I am concerned about anything and everything that would be inflammatory and add to the horrible inflation triggers we have,” Manchin said Wednesday when asked about adding ACA subsidies to the package.

Manchin added he doesn't want to talk about "anything that would be inflammatory," as inflation reached a record-breaking 9.1% last month. 

Other senators said they are still hoping to get a subsidy extension in the package. 

“I am spending a big chunk of my waking hours fighting to hold down people’s premiums,” said Sen. Ron Wyden, D-Oregon, on Wednesday.

Manchin reached a deal with Senate leadership to give Medicare the power to negotiate for lower drug prices on a narrow list of products. It would include other reforms such as a cap on monthly cost-sharing payments for Part D and Medicare Advantage plans and a repeal of the controversial Part D rebate rule. 

Senate Democrats aim to use a parliamentary procedure called reconciliation that ensures any budget bill can pass the chamber with a strict majority vote, thus avoiding the 60 votes needed to break a legislative filibuster. Democrats have a tenuous majority with Vice President Kamala Harris the tiebreaker in a 50-50 Senate.

Democrats had aimed to use the same procedure for the Build Back Better Act last year, which included an extension of the ACA subsidies until 2025. However, Manchin objected to the $1.75 trillion package, saying it could contribute to inflation and high government spending.

Manchin’s reluctance to embrace enhanced ACA subsidies comes as insurers and regulators are hoping to get a deal soon as plans are now formulating their rates for 2023. 

Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure has said that plans need to hear as soon as possible ahead of the Nov. 1 open enrollment for the ACA exchanges. Provider and payer groups have been imploring Congress to extend the subsidies to stave off major premium hikes. 

“Millions of Americans are counting on Congress, as cutting the financial help that the law provides means many families will face the difficult choice of becoming uninsured and rolling the dice if they get injured or sick,” said Jessica Altman, executive director for Covered California, the state-run ACA exchange, in a statement.