The price increase will affect an estimated 13 million people nationwide, potentially adding hundreds of dollars to families ’monthly expenses. And in a painful turn for the White House, which is already trying to contain its anger over rising household spending, voters will begin receiving notifications of their premium increases in October – around the same time as they begin voting in the interim.

“It’s not very good when you go to the midterm elections,” said Sabrina Carlett, co-director of the Center for Health Insurance Reform at McCourt School of Public Policy at Georgetown University. “There can be some really horrible stories about people losing coverage.”

The scenario has alarmed vulnerable lawmakers and White House allies who in recent weeks have privately warned senior Democrats that the issue could cost Democrats control of the Senate and destroy their hard-earned reputation as health care parties.

In polls, voters are constantly assessing the availability of medical services as the main domestic concern, second only to inflation. The increase in subsidies was adopted in March last year under the Biden program American plan of salvation – also pushed Obamacare registration to new highs by adding 2.5 million new entrants for one year.

“It was a major achievement,” said Emily Gee, health policy coordinator at the Progressive Center for American Progress, which maintains close ties to the Biden administration. «[But] when autumn comes, people will look for higher bonuses, and that will be the main thing – not the fact that Congress has reduced the bonuses. “

Health experts predict that the abrupt abolition of subsidies will especially change the coverage of black people and those living in the red states who have not expanded Medicaid. For millions more their monthly premiums will potentially grow.

Despite the urgency, Democrats acknowledge that there is only one way to prevent a catastrophe: make a deal with the Senate. Joe Manchin (DW.Va.) on the reconciliation package.

It is projected that the maintenance of subsidies will cost tens of billions of dollars a year. And while Republicans unanimously oppose their continuation, including inclusion in a broader party bill is the last option available before the by-elections.

This added another wrinkle to the negotiations between Manchin and the democratic leaders, who have so far focused on only three areas: climate, drug prices and deficit reduction.

Manchin’s staff and the leader of the majority in the Senate Chuck Sumer spent the last couple of weeks sharing preliminary ideas on what the bill framework might look like, said three people who are aware of the issue. Discussions have strengthened hopes that an agreement will still be reached, although a breakthrough to Remembrance Day is not enough.

Another sign that negotiations are still in their infancy, the White House has limited its direct involvement in negotiations, and aides prefer to follow the discussion from afar until it becomes clear that significant progress has been made.

Representatives of Manchin and Sumer did not respond to requests for comment. A White House spokesman declined to answer specific questions about the story, citing the administration’s policy against discussing its talks with individual lawmakers.

While the initial focus on key elements of the package has pushed Obamacare subsidies into the background, they have recently become the subject of more intense attention. On Tuesday, senior White House aides and senior health officials met with more than a dozen heads of state health exchanges to discuss the possible expiration of grants, asking them for details on how price increases will occur in individual states and what impact they will have. across the country.

The exchange directors warned the group, which included Deputy Director of the Internal Policy Council Kristen Linke Young, Deputy Health Minister Andrea Palm and Medicare and Medicaid chief Chikita Brooks-LaSur, that the loss of aid would lead to higher spending on families already stretched by growth. gas and products. prices.

They also stressed that Congress is working on time to avoid chaos and confusion. Insurers will start setting their rates this summer, in preparation for notifying applicants will come in the fall.

“Any additional growth in health insurance just won’t be sustainable for people,” said Mila Coffman, head of the Obamacare DC exchange. “They will choose between eating, going to work or keeping a roof over their heads.”

Democrats in the Senate are also concerned about the impact that the shock could have on their ability to keep control of the House. Anxiety was further prompted by a desire to pass a reconciliation bill by July 4, just before insurers in many states begin to record rate increases.

If they fail to do so, aides and others familiar with the debate said, it is widely acknowledged that Democrats will take most of the blame from voters who tend to spread their frustration to those in power.

“It would be a legislative violation,” said one man who worked with Democratic leaders on the issue. “It plays on the inflation concerns that all consumers have.”

Although Democrats are trying to avoid this political danger, they acknowledge that they must first force Manchin to agree on key elements of the reconciliation bill. Although in the past he has supported the expansion of Obamacare, Manchin has so far given no determination to add subsidies to the final bill.

“I don’t know how many times I could do it over and over,” he said this week. “You get taxes, you get medicine, and you can get an energy / climate bill.”

Health officials continue to say they are confident that grants will be first in line for inclusion once these key issues are addressed.

“No one doubts the value of politics,” said Elliott Fishman, senior director of health policy at the progressive advocacy group Families USA. “This is an area that unites a democratic group more than any other.”

But just in case, they increase the pressure behind the scenes. U.S. Families is published this week new analysis assessing the increase in the premium from state to state, noting, in particular, that residents of Manchin “will experience the greatest growth in the country.”

And after meeting with senior Biden officials on Tuesday, directors of state exchanges headed to the Capitol to make a similar statement to Hill staffers, who included top aides to the Speaker of the House of Representatives. Nancy Pelosiminority leader in the Senate Mitch McConnell and the Senate Finance Committee.

The high-level meetings show great concern about the expiration of grants, said Coffman, director of exchange at DC. But none of these sessions ended with signs that the Democrats have a solution.

“I at least felt,” she said, “that everyone understands that deadlines are needed urgently.”

Burgess Everett contributed to this report.

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