Next year, when her health care premium balloons, "it's gonna be a real hit," Ellen Allen says. "I'm worried about it."
Allen lives near Charleston, W.Va., and directs a nonprofit called West Virginians for Affordable Health Care. She buys her insurance on Healthcare.gov, and right now, the 63-year-old pays $479 a month. "I've been really happy with my coverage," she says.
All of that is changing soon. The federal tax credit that makes the coverage affordable for Allen and millions of other Americans expires at the end of the year. The credit was a pandemic-era relief measure that has contributed to record enrollment in the insurance sold through the Affordable Care Act Marketplaces.
Average spike? 75%
The average enrollee will see their premium costs increase 75%, according to an analysis of insurance filings by the nonpartisan health research organization KFF. For many people, those increases will be even higher.
Allen, who's well versed in these issues because of her job, used KFF's online calculator to estimate what her premium will be after the enhanced subsidies expire.
"Next year it's gonna be like $2,800 a month," she says, just for her individual plan. She estimates that she could have $10,000 in out-of-pocket costs on top of that.
She says it's still worth it to her to have the plan because she has expensive prescriptions. "Like an asthma medication [that] can run $700 a month. There's an eye drop medication that can be $800 a month," she says. "And these are the differences in keeping my vision, for example, so I have to do that."
She's started setting money aside every month and directing it into a separate account to start building up savings for those high premiums next year. "Luckily I can do that, but that's money I won't be able to save for investing in my 401K for retirement," she says.
"I wish I were older"
One good thing, she says, is that she'll turn 65 next year and be able to enroll in Medicare, so she will only be on the hook for the high premiums for eight or nine months. "It's the first time in my life I wish I were older," she laughs.
Rates could change before open enrollment for Healthcare.gov and the state-based marketplaces begins November 1. And Congress could also act before December to blunt the effect on enrollees, although the Republican lawmakers who control Congress have shown little interest in extending the subsidies. An extension of the tax credits was left out of President Trump's tax and spending law passed in July.
People who can't afford the higher premiums and are healthy enough will likely go without health insurance. Several enrollees told NPR that's their plan — to roll the dice, taking the chance that they stay well and don't have a big health expense.
The Congressional Budget Office estimates that the end of the enhanced tax credits will increase the number of uninsured people in the country by 4.2 million over the next decade. More Americans are also likely to become uninsured because of cuts to the Medicaid program in the law known as the "Big, Beautiful Bill."
A new job, maybe a new wife
Sidney Clifton would really like to keep his Healthcare.gov plan. He says it works for him, and he has chronic health conditions. "Diabetes, I have congestive heart failure —just your normal overweight American, like everybody else," he says.
Clifton is 54 and lives in Pasco County in central Florida. "I work for a car dealership — it's a mom-and-pop store, not very big, like ten employees," he says. He likes working for a small business, but it means no health benefits.
Right now, his full premium is about $1,100 per month, but with the enhanced subsidies, "my portion is $298." He doesn't know how much more he'll have to pay every month next year without the subsidies.
"I could probably go up to $800 to $1,000," he says. "$1,000 would be really, really pushing me hard."
If it's higher and he just can't afford it, he says, he might look for a job at a bigger corporate dealership that has benefits.
Or, he says, "I'll find me some woman [who has insurance] and get married again." He says he'd rather not do that.
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