Burcum: Debate over Affordable Care Act financial aid is central to the government shutdown

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A soybean export crisis is already jeopardizing Minnesota farmers’ financial health. Now Congress is set to deliver another blow to their bottom lines by rolling back the Affordable Care Act‘s enhanced financial aid, which lowers monthly premium costs for many farm families, just as 2026 coverage costs are set to soar.

Unlike the weather or other natural threats, the trade and insurance troubles are entirely manufactured.

Cratering soybean sales to China are fallout from President Donald Trump’s trade war. The ACA’s enhanced aid, which made many middle-class consumers newly eligible for assistance, was first enacted in 2021 and then renewed for three years in 2022. It sunsets this year. But it doesn’t have to, and it shouldn’t.

The enhanced tax credits made coverage more affordable for many who struggled with its costs, including farm families, early retirees, the self-employed and other middle-class Minnesotans who buy coverage on their own instead of getting it through an employer. In doing so, it provided a necessary fix to the ACA, which initially set income eligibility for the law’s tax credits too low and left too many struggling to buy a quality health plan.

If action isn’t taken, coverage will certainly be more challenging to pay for and potentially out of reach. The nation’s uninsured rate is at historic lows. This is not the time to abandon the work that made this progress possible. A timely congressional fix would not only avoid reversing these gains, but is also part of the solution to ending the federal government shutdown.

It’s frustrating that this important consumer health issue is now caught up in the shutdown debacle. I began sounding the alarm about the expiring enhanced ACA aid in an Oct. 5, 2024, column. It should have been dealt with by now. Whether it’s a part of reopening the government or not, a firm commitment and swift action is imperative because the window of time for a solution is closing rapidly.

Open enrollment, the period when people buy coverage for the following year, begins Nov. 1 in Minnesota and runs through Jan. 15. It’s less than a month before those who buy their own coverage start shopping for a 2026 plan.

Consumers need to know as soon as possible if the expanded aid will be there as they research options and decide which insurance plan will best meet their needs. Without this assistance, they may have to choose plans that have higher deductibles and other out-of-pocket costs. The worst-case scenario is that they can’t afford to buy any plan, which leaves them at considerable risk if a serious medical need develops.

The Minnesota Department of Commerce’s Oct. 1 release of finalized health insurance rates for 2026 underscores the urgency for congressional action. Commerce warned of “significant health insurance rate hikes” ahead for those who buy in the individual market or are in small-group plans.

Consumers who buy plans on their own, such as through MNsure or a broker, “face an average rate increase of 21.5%, while those in small group plans face a 14.2% increase.” The rates would have been even higher had Minnesota lawmakers not extended a vital state program that helps stabilize insurance rates in the individual market.

A closer look at the individual market buyers illustrates who stands to benefit if Congress does so. While Minnesota data isn’t available, analysis of national data is available from KFF, a respected health policy nonprofit.

“On average, 8% of adults under age 65 who usually worked more than 20 hours per week in 2023 got their coverage in the individual market,” according to the KFF report. But in certain occupations, “more than a quarter” do so. These include chiropractors and dentists, real estate brokers and farmers, ranchers and agricultural managers. That last group is an especially important part of Minnesota’s economy, and on average, 27% buy coverage on their own, KFF reports.

MNsure is the state’s official online insurance marketplace. CEO Libby Caulum said in a statement this week that “Without enhanced premium tax credits, nearly 90,000 Minnesotans will see an increase in what they pay for coverage.”

If Congress doesn’t act, ACA subsidies will once again cut off at incomes exceeding 400% of the federal poverty level. In my reporting, many retirees and farmers have incomes just over this line: $62,600 for an individual or $84,600 for a couple, according to U.S. Department of Health and Human Services data. The rate hikes just announced will make affordability a challenge for those in this group.

If Congress doesn’t act, ACA subsidies will still be available for plans sold on MNsure for those with incomes under 400% of the federal poverty level who meet other eligibility criteria. But the assistance available will be less generous, with Minnesotans earning between 200% and 250% of the federal poverty level especially taking a hard hit. They could see average monthly costs nearly double, from about $150 to $283 a month.