WASHINGTON (AP) — Fifty-two-year-old Dinam Bigney was in debt and had to get a roommate this year, due to health insurance premiums costing him $900 a month.
Next year, those monthly fees will increase by $200 — a significant enough increase that a program manager in Aldi, Virginia, has resigned himself to finding cheaper coverage.
“I can’t afford it, because I’ve exhausted any savings I have now,” he said. “The emergency fund is still going out — that’s the scary part.”
According to a new survey by health care research nonprofit KFF, Bigney is one of many Americans who rely on Affordable Care Act Marketplace health insurance plans who are already struggling with high health care costs.
A majority of more than 1,300 enrollees surveyed in early November, per KFF, more than 90% of enrollees, expect their health costs to be affected next year if the COVID-era tax credits that help pay health insurance premiums do not expire. The prospect of expansion seems increasingly unlikely.
Enhanced premium tax credits, set to expire at the end of this year, have been at the center of recent tensions in Congress, with Democrats calling for an outright extension and many Republican lawmakers strongly opposing the idea. Their inability to agree on a way forward prompted a record 43-day government shutdown earlier this fall.
President Donald Trump and some Republicans in Congress have floated proposals in recent weeks for short-term extensions or reforms to the Affordable Care Act, but no plan has emerged as a clear winner. Meanwhile, the window for Americans to shop for next year’s plans is well underway with less than a month to go before the subsidies expire.
KFF’s poll shows market entrants — most of whom say they will be directly affected by the end of subsidies — overwhelmingly favor the expansion. The poll found that this group is more likely to blame Trump and Republicans in Congress than Democrats if the tax credits are due to expire.
Enrollees already find it challenging to afford health expenses
The expiration of the tax credit — which a separate KFF analysis found would more than double monthly payments for the average subsidized enrollee — comes as Americans are already saddled with higher health costs, the survey shows.
About 6 in 10 Affordable Care Act enrollees find it “somewhat” or “very” difficult to afford out-of-pocket expenses for medical care, such as deductibles and copays. That’s more than half of enrollees who find it challenging to afford health insurance premiums. Many also say they can’t afford a $300 per year increase in their health insurance costs without significantly straining their household finances.
Cynthia Cox, vice president of KFF, who leads the organization’s ACA research, said the population of Americans on Affordable Care Act health insurance includes some high-income entrepreneurs and small business owners, but the vast majority of enrollees are low-income and therefore at risk of even small increases in health costs.
“These are going to be mostly people who are living paycheck to paycheck, who also have unstable or unpredictable incomes,” she said. “The increases that many of them are facing are going to be a kind of financial hardship for them.”
Most enrollees see cost increases on the horizon
A little more than half of those enrolled in the Affordable Care Act marketplace believe their health insurance costs will rise “more than usual” next year, according to the survey. Another 4 out of 10 predicted increases would be “slightly higher than normal” or “the same as normal”.
Larry Griffin, a 56-year-old investment banker and financial adviser in Paso Robles, California, pays $920 a month for his gold-standard health plan through the state’s insurance marketplace. He says the price will go up to $1,400 a month next year — with a jump in copays and his annual out-of-pocket maximum.
He’s worried the increase will affect his ability to save money for his upcoming retirement, but with the recent amputation of his left leg below the knee and other health issues, he said he can’t risk downgrading health insurance or his plan.
Griffin is one of about three-quarters of market enrollees who say health insurance is “very important” to their ability to access health care.
“I’m not going to say I can’t manage it, I can, but it’s another one of those things,” he said. “Here’s, you know, knock number 5,000 against me after all the other things I’ve had to deal with.”
Patricia Roberts, 52, a full-time caregiver for her daughter in Auburn, Alabama, expects her monthly health insurance premiums to rise from about $800 a month to $1,100 a month next year — an expense she can manage. But his friends across the border in Georgia are looking to double the monthly fee next year.
“I don’t know how people are going to survive, it’s already a struggle to pay for food and everything else,” Roberts said.
Support for expansion has spread across political parties
Polls show that allowing the enhanced tax credits to expire would be highly unpopular with enrollees in the current marketplace.
Support for continuing the tax credits extends across party lines. Almost all Democrats and 8 in 10 independents enrolled in marketplace plans say the credits should be expanded, as do 7 in 10 Republicans. Support is about the same among Republicans and Republican-leaning independents who support the MAGA movement and those who don’t.
Yvette Laugier, 56, a Republican in Chicago, said while her income is too high to qualify for the increased premium tax credits, she supports extending them temporarily with additional fraud protections to give low-income enrollees more time to consider their options.
Among those who think Congress should extend credit, 4 in 10 said Trump would deserve “most of the blame” if they were allowed to expire, and nearly a third said the same about Republicans in Congress. Democrats in Congress are far less likely to be blamed: Only 23% of those who nominated said they would deserve greater responsibility.
In Virginia, Bigney said the blame should be split between both Democrats and Republicans. But he hopes they can come to an agreement and potentially a temporary extension in the coming weeks.
“They have to sit down and really look at what’s best for the American people as a whole,” he said.
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Swenson reported from New York.
