Manchin Pushes Even More Healthcare Means Testing as West Virginians Suffer

Having tanked his party's effort to expand Medicare and close the Medicaid coverage gap, Sen. Joe Manchin is now dangling his support for an extension of Affordable Care Act subsidies as massive premium hikes loom for millions of people who buy insurance on the exchanges.

Insider reported Wednesday that Manchin has "signaled he's open to extending enhanced subsidies under the Affordable Care Act, a move that would help Democrats avert a huge political threat in the November midterms."

The American Rescue Plan—a Covid-19 relief package that President Joe Biden signed into law last year—included provisions that boosted ACA subsidies for low-income people and ended the income cap on subsidies. The changes were aimed at ensuring no one is forced to pay more than 8.5% of their total income to purchase health coverage in the ACA marketplace, which can be prohibitively expensive without federal subsidies.

But the provisions are set to expire at the end of the year in the absence of congressional action, sticking the roughly 14 million people who buy insurance on the ACA exchanges with dramatically higher premiums. Notifications of premium increases would begin going out in October, just ahead of the crucial midterm elections.

Even though eligibility for ACA subsidies—which progressives often characterize as gifts to the insurance industry—is already restricted on the basis of income, Manchin told Insider that he wants even more means testing, which he called "the main thing."

"We should be helping the people who really need it the most and are really having the hardest time," said Manchin, who supported the ACA subsidy boost in the American Rescue Plan. "With healthcare, people need help. They really do."

That's certainly true of people in his home state of West Virginia. After visiting a free medical clinic located just miles from Manchin's riverfront home in Charleston, The Lever's Andrew Perez reported earlier this week that one resident, Charles Combs, "has resorted to extracting his own teeth because dental care is too expensive."

Traditional Medicare currently doesn't cover dental services. Late last year, Manchin blocked an effort—spearheaded by Sen. Bernie Sanders (I-Vt.)—to expand the program to cover dental, vision, and hearing.

"The Charleston clinic made clear just how badly people need such care—and not just seniors, and not just West Virginians. Combs, for instance, is still in his 50s, while the clinic saw patients of all ages driving hours from Ohio, Kentucky, and Virginia," Perez noted. "The [Remote Area Medical] clinic hinted at the kind of universal healthcare system America could have, if not for senators like Manchin and their healthcare industry donors."

"The organization doesn't ask patients about what its team calls the 'three I's': identification, income, or insurance," Perez continued. "Patients are treated with kindness, compassion, and professionalism—and fairly quickly. All services are free."

In an interview with Punchbowl News this week, Manchin voiced concerns about the price tag of extending the ACA subsidies—scrutiny he has not applied to the trillions of dollars in Pentagon spending he's voted for over the past decade.

"The bottom line is there's only so many dollars to go around," Manchin said.

According to a recent analysis by Families USA, the roughly 23,000 West Virginians who buy health insurance coverage on the ACA exchanges will see their annual premiums rise by an average of $1,536—63%—if Congress lets the subsidy provisions expire.

"With little debate or media focus, Democrats are on the verge of dooming millions of Americans to huge new healthcare bills, which will in turn serve to ruin any hope Democrats have of winning the midterms," journalist Jon Walker warned in The American Prospect earlier this year. "Beyond broadly hurting 14 million people, the end of these subsidies will create thousands of uniquely horrific stories of financial devastation."