Health insurance bonuses for millions of Americans will go up if Congress doesn’t take action in the coming months, with particularly large increases in politically contested states, according to a report that the liberal advocacy group United States Families made public on Monday morning.

The subject of the report is the fate of some additional, but temporary, financial assistance offered to people who take out insurance on their own through or state-run online marketplaces like the Maryland Health Connection, Minnesota MNSure and Your Idaho Health.

Help, that the president Joe Biden and Democrats signed into law under last year’s COVID-19 relief package, slashed premiums by hundreds, if not thousands, of dollars a year.

But the aid is due to end in December. If that happens, prices will rebound and consumers will start taking notice of the increases in the fall.

Monday’s Families USA report breaks down what that would mean in the 33 states using, based on a simple calculation using data that the US Department of Health and Social Services released earlier this year.

On average, according to the Families USA report, premiums for people purchasing individual coverage would increase by 53%, with the lowest average increases in New Hampshire (28%) and the highest in Wyoming (132%). .

“These premium increases are very significant,” Frederic Isasi, executive director of Families USA, told HuffPost via email. “People are going to see their premiums increase by more than half – at a time when inflation is on the rise and families are struggling to pay all their bills.”

None of this should come as a surprise. In September, researchers from Henry J. Kaiser Family Foundation issued a separate notice report plan for significantly higher premiums if the additional assistance expires.

The impact would be particularly harsh for low-income people who buy market coverage, the Kaiser report notes, as many would react by switching to cheaper and less generous plans that leave people with higher fees.

“If the [extra] subsidies expire, almost all of the 13 million people with subsidized coverage in the markets will see an increase in their refundable premium payments, and for many it will be the biggest increase they have seen since the opening of markets, Cynthia CoxKaiser’s vice president and director of its Affordable Care Act program, told HuffPost.

The Democratic proposal is in legislative limbo

The question has always been whether lawmakers would act to avoid this situation. So far they haven’t, although Biden and Democratic leaders have tried.

A key provision of theBuilding back better“The legislation they crafted last year would have extended help for several years. Their effort collapsed in December, following a series of objections of the senator Joe Manchin (DW.Va.), whose Democrats would need a vote in the equally divided Senate because no Republicans support the legislation.

Biden, the Democratic leaders and Manchin have all said they would still like to enact some of the provisions of Build Back Better, as part of a much smaller bill. But there has been no visible progress towards a compromise.

And it’s unclear how many Democrats recognize what the higher bonuses would mean for their constituents — or how the price increases would ripple politically, especially at a time when polls show the rising cost of goods and services is the main concern of voters.

“Families will start receiving notices of soaring premiums just weeks before the midterm elections,” Isasi said. “Some of the most closely watched states – for example Florida, North Carolina, Georgia and Arizona – will see some of the largest increases.”

Democrats have always wanted to strengthen the ACA

The cost of insurance at and state-run marketplaces has been a frequent source of public frustration and political unrest since the Affordable Care Act took effect in 2014.

Although millions of people saved money or obtained coverage for the first time, millions more remained uninsured or faced premiums and disbursements. A big reason for this was that former President Barack Obama and Democratic leaders like House Speaker Nancy Pelosi (D-California) had to cut the program, cutting its financial aid, in order to accommodate more conservative Democrats whose they need.

Obama, Pelosi and their allies have always said they hope to go back and put more money into the law known as Obamacare, which is precisely what Biden, Pelosi and the rest of the Democratic leadership of today have done with the COVID-19 bill ― and what they hope to continue to do, if they can find a way to pass legislation extending aid beyond 2022.

Republicans have shown no interest in extending aid, or any broader legislation that might include it, in part because the money to pay for the extension would come from sources that Republicans traditionally oppose. , like higher taxes on the rich. That left Biden and his allies completely dependent on Democratic votes in the Senate, where support from Manchin and Arizona’s Kyrsten Sinema has proven particularly hard to come by.

Both have constituents who would face premium spikes because they get insurance through And in nominal terms — that is, dollars rather than percentages — West Virginia would actually be the state where people are facing the highest average premium increases, from 1 $536 per year.

Monday’s report could make these two lawmakers, and the rest of their colleagues, understand this — if they pay attention.