Deal or no deal? States are preparing for Congress to take last-minute action on Obamacare

Saturday is the day nearly 24 million customers can start purchasing health plans on healthcare.gov and the state-run Obamacare exchange.

Higher prices and uncertainty await many of these shoppers.

Insurance premiums are expected to average more than double. Managers who manage marketplace enrollment in states including Maryland, California, Pennsylvania and Idaho told me and my colleague Julie Appleby that people are wondering how they will raise hundreds — or even thousands — of extra dollars next year to pay for these plans. Some people are considering plans with five-figure deductibles, like a Virginia Beach, Va., family facing a $20,000 deductible to keep their monthly premiums near $70.

“It may seem cheap in terms of premium, but the coverage itself will end up costing that family a lot more,” Deepak Madala, director of Enroll Virginia, told me this month.

Even as Americans consider expensive plans, there’s a very real possibility that everything could change if Congress reaches a last-minute deal to extend benefits before the end of open enrollment, which runs through Jan. 15 in most states.

Behind the scenes, state exchange managers are developing contingency plans.

And in Idaho, the state’s stock exchange director says he has “notifications ready to go” if Congress comes up with something. California and Maryland are preparing to temporarily close open enrollment if lawmakers agree to extend benefits.

On Capitol Hill, insurance companies are warning lawmakers that time is running out.

“If things continue beyond the first week of December, it will become more complex operationally,” Chris Haltmeyer, vice president for legislative and regulatory policy at the Blue Cross Blue Shield Association, told me.

However, a month into the government shutdown, Congress does not appear to be close to reaching an agreement to extend additional subsidies that have made marketplace health insurance more affordable since 2021, when Democrats first approved a law providing significant assistance to pay premiums.

Republican and Democratic leaders have expressed a desire to find a solution before these subsidies expire at the end of the year.

But as is the case in Congress, each party has different ideas about what a deal might look like. Lawmakers have not even agreed on how to take the first step. Democrats demanded an agreement on supporting the ACA before they voted to fund the federal government. Meanwhile, Republicans have refused, saying they will not negotiate until the government reopens.