Contained inside the Democrats’ $1.9 trillion coronavirus stimulus bill is a political time bomb for Republicans.

Included in the bill’s long list of stimulus spending is a provision that delivers on President Biden’s promise to strengthen the Affordable Care Act or Obamacare.

Obamacare’s big failure has been what it did not do to help––and actually hurt––middle-class buyers of individual health insurance. Since the health law’s inception, consumers, who are eligible for little or no Obamacare subsidy, have faced daunting premiums and out-of-pocket costs.

In 2021, for example, a family of four with mom and dad age 40 in the Alexandria, VA zip code would find that the cheapest unsubsidized silver plan would cost $18,046.32 in annual premiums, with a per person deductible of $6,500 a year.

Candidate Biden’s plan would fix that by capping what people at any income level would pay for marketplace plans at 8.5% of their income––the 400% of the federal poverty level cap on subsidy eligibility would no longer apply.

A family of four making the current 400% of poverty level annual income of $106,000 would pay no more than $9,010 in annual premiums (8.5% of their income) under the new rules.

The House passed stimulus package includes this and goes even further by letting people who earn up to 150% of the federal poverty level get full subsidies and also by extending full subsidies to those receiving unemployment benefits.

At 150% of the federal poverty level, four-person families earning up to $39,750, and individuals earning up to $19,320, would pay nothing in premiums for their Obamacare individual health insurance under the House-passed plan.

The House stimulus bill would also cover 95% of Medicaid expansion costs for states that have not yet expanded––up from the baseline 90% match.

The Congressional Budget Office has estimated that these changes would cover 1.3 million more people and cost $34 billion.

If these changes survive in a Senate-passed coronavirus stimulus bill, they would dramatically improve the costs middle-class individuals and families face on the Affordable Care Act’s insurance exchanges and encourage states to expand their Medicaid programs.

But here’s the catch. These improvements are part of a temporary stimulus bill and would only apply to health insurance subsidies and federal Medicaid costs in 2021 and 2022.

On January 1, 2023, the Obamacare insurance subsidies would revert to the old levels that have caused middle-class families to face these huge premiums.

What else is happening at the end of 2022? The Congressional elections.

This would make Obamacare another huge election-year issue.

Would Republican House and Senate candidates support making these middle-class improvements to the Affordable Care Act permanent, or would they call for letting them drop?

Now, that is one heck of an ugly election-year choice for Republicans who have consistently called for Obamacare to be repealed and replaced.

If Democrats can succeed in keeping these substantial improvements to Obamacare in a stimulus bill they can get passed through the Senate, they will have set one whopper of a political time bomb for Republicans come November 2022.

Robert Laszewski is president, Health Policy and Strategy Associates and blogs at Health Care Policy and Marketplace Review.

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