Senior health care executive John Driscoll called the impending expiration of Affordable Care Act subsidies “a tragedy in the making,” warning that millions of Americans will be hit by rising premiums, reduced coverage and rising medical debt as the gridlock intensifies in Washington.
Driscoll has a 25-year career in health care, including serving as chairman of UConn Health Walgreens Boots Alliance The president said the policy reversal amounted to “self-inflicted harm” that would drive up costs for low-income families and wealthy professionals who thought they were unaffected.
Driscoll cited Congressional Budget Office estimates that premiums would rise sharply if Congress allowed subsidies to lapse. Approximately 24 million market participantsand about 2 million people Coverage will be completely lost in the short term.
An enhanced premium tax credit, introduced during the pandemic and extended through 2025, has helped double marketplace enrollment and keep average subsidized premiums at about $900 a year. When they expire, KFF News expects Approximately 114% increase By 2026, average premium payments for subsidized enrollees will increase. Older adults and rural residents are particularly vulnerable, with KFF also warning that adults aged 50 to 64 may be at risk Average premiums increased by 75% or more.
Intangible tax on everyone else
What’s really happening, Driscoll argued, is that costs are being shifted from the government to families and employers amid Medicaid cuts, work requirements and subsidy rollbacks. He noted that when people lose coverage, they “do not stop getting coverage from the health care system.” Instead, they present later and are sicker, so hospitals and insurance companies respond to uncompensated care by raising prices.
He added that when you consider that this is being done to “effectively subsidize tax breaks for millionaires and billionaires, when people lose coverage, it’s going to shift the cost of health care onto all of us,” referring to the One Beautiful Act that extended President Donald Trump’s previous tax cuts and introduced new ones.
For Driscoll, the subsidy cliff exposed a deeper “tribal dysfunction” in health policy that froze the Affordable Care Act rather than improving it. He called Obamacare “a very good but imperfect solution” that cut the uninsured rate by about half and slowed health care inflation, but said both parties refused to engage in the hard work of updating it. “We’re really not prioritizing patients,” he said. “We’re prioritizing politics,” leaving millions of people facing the choice of foregoing coverage or delaying care for serious illnesses.
political situation
He issued a warning to Republicans, calling the looming mass expiration of health insurance subsidies a “self-inflicted wound” for the party. “They were elected to solve the affordability problem,” and now they will accelerate that problem, he noted. But Driscoll said no party is blameless. “Sadly, neither side wants to have an intelligent conversation about how to actually take care of more people and get them to better care earlier.”
It’s true that Democrats pushed for the Affordable Care Act, but Driscoll said that overall they were committed to defending what was itself a compromise while the other side was on offense. “The danger is that some Democrats don’t want to have a conversation about the development of the Affordable Care Act because they feel they have to defend it, and Republicans don’t want to have a conversation about the development of it because they want to destroy it. The result is that you end up here, in “this ridiculous no-progress zone.” (Driscoll did reveal that he is serving as special adviser on health care to Connecticut Governor Ned Lamont.)
From today’s perspective, Driscoll believes that the reason America suffers from ongoing health care problems is because of mismatched incentives. “Health care is a team sport that is constantly shaped by individual incentives,” he said, noting that U.S. health care costs are twice as high as in the average industrialized country and productivity is far less than in industrialized countries.
In similar countries, about 50%-60% of physicians work in primary care, but only a quarter in the United States. The thing is every doctor wants to be a specialist or a surgeon because they will about twice the salary Pediatrician or internist way. “Unless you change those incentives, people are going to continue to go to those fields that pay better.”
Driscoll said there is currently no solution to the problem, but there are steps we can take. He pointed to expanded drug price negotiations, immigration reform to alleviate shortages of primary care doctors and nurses, “site-neutral” payment approaches (so patients are not charged more for the same hospital care) and broader use of value-based bundled payment models. But he argued that we don’t seem capable of even participating.
“If the two sides can talk, they might be able to agree on how to bridge the differences between Biden and Trump on drug costs. If we can talk, we might be able to agree on how to restore value-based care that balances the interests of doctors and hospitals with patient outcomes and the obligations of the government,” Driscoll said, “if only.”