Congress' Obamacare subsidy vote could set off state scramble [View all]

Source: Politico

11/16/2025 07:00 AM EST


The nation’s 20 state Obamacare exchanges appear poised to quickly update premiums if Congress passes a straightforward extension of enhanced subsidies when it votes on the matter next month. But there’s another, increasingly likely scenario that could catch them flat-footed. That’s if lawmakers decide to go a different route – for example, by paying the subsidies directly to consumers, a plan touted by President Donald Trump, or changing the eligibility rules by adding an income cap, which many conservatives would like to see.

“If it is more complex, if they start to change the contribution amounts … that sends us back to the drawing board,” said Lindsay Lang, director of Healthcare RI, Rhode Island’s Affordable Care Act exchange. “That would add time and complexity.” As part of a deal to reopen the government earlier this week, the Senate will vote on a subsidy extension by the middle of December. A straightforward extension of the subsidies, which expire at the end of this year, could be calculated within a couple weeks and communicated to consumers, several officials at state exchanges told POLITICO.

But it remains unclear if there will be bipartisan consensus on a deal, let alone a clean extension, or if the House would pass it. Open enrollment began Nov. 1 and will end, depending on the exchange, in mid to late January. The enrollment deadline for the federal exchange, Healthcare.gov, which covers 30 states, is Jan. 15. Consumers must sign up for a plan in mid-to-late December if they want insurance coverage to begin in January.

If Congress hasn’t reached a deal that would lower costs by then, they could either pay higher premiums for their preferred plan or pick a plan with less coverage. Some consumers could decide to do without coverage until February to wait and see if a deal is made and then pick a plan in January, or they could drop out altogether. State exchanges, and the exchange run by the District of Columbia, are preparing to update their systems and reach out to affected consumers as speedily as possible about any price change.

Read more: https://www.politico.com/news/2025/11/16/states-prep-for-daunting-task-of-implementing-a-health-subsidy-extension-if-it-comes-00653131