I have been on a multimonth mission to figure out why health care costs are going up. You can read all about it here.
As part of that process, I spoke to people across the United States to hear about their experiences with health insurance. And let me tell you, it’s dire. Take a listen.
Celia Monreal, who lives in Tyler, Texas, said she doesn’t pay a premium right now for her Affordable Care Act (ACA) marketplace plan, and tax credits would keep her monthly premium below $200 next year. But if congressional Republicans continue to block an extension of those tax credits, which are set to expire at the end of the year, she could be paying $1,500 per month.
“Considering the bills and everything else, we wouldn’t be able to afford a $1,500-a-month increase for health insurance,” Monreal told me.
Her heat bill can sometimes reach $1,000, and the rising cost of living has made it harder to care for her five children, four of whom are under age 16 and live with her. If ACA subsidies expire, she’d have to choose those necessities over health insurance. She might also need to travel to Mexico and pay out of pocket for an operation her husband may need—a cheaper option, she says, than paying monthly for US health insurance without the subsidies.
She blames the president she once supported for putting her in this position. Monreal says she’d always voted Democrat until casting a ballot for Donald Trump last year. Now, she feels “disappointed and kind of ashamed” for many reasons—Trump’s opposition to extending ACA subsidies, his immigration crackdown, economic hardships, and more.
Her disappointment extends beyond Trump and to other congressional Republicans. Congress has now adjourned for the rest of the year with no solution to the subsidies.
To Monreal, it’s more than just horse-race politics. “It’s not fair that they think they can move these pieces around in people’s lives like it’s nothing, like we’re nothing.”
Michael Swanson, a restaurant server in San Antonio, relies on tax credits to keep his ACA health coverage. With those subsidies set to expire at the end of the year, he says the same plan he’s on now would cost him 10 times more than it currently does.
Because of congressional Republicans’ refusal to extend these subsidies and Democrats’ acquiescence to their colleagues across the aisle during the recent government shutdown, Swanson says he needs to find a new job that will provide him affordable health coverage at a sooner date than his current job would.
Steve Gomez, a construction manager in Gilbert, Arizona, relies on ACA marketplace coverage for his and his family’s health care—including his son Anthony, who was born with a congenital heart defect.
He’s used tax credits in the past to help pay for his marketplace plan but elected not to this year. And next year, though his health care costs are set to go down per month, he tells me he cannot find a marketplace plan that covers the care Anthony needs.
And he believes the impending expiration of these tax credits is largely to blame: Because insurance companies can’t predict revenue, he says, they’re offering more limited care, and the effects of that trickle down to him and his son.
In Kanab, Utah, photographer Stacy Cox received a letter from her marketplace insurer saying her monthly premium would increase by a whopping 50 percent—even if lawmakers extended tax credits.
If she loses her $1,415 tax credit, her monthly premium would rise to $2,168. “So if these credits aren’t extended, we don’t have health insurance,” Cox says.
Andrew Volk, a bar owner in Portland, Maine, told me several times that he isn’t an economist. But as a small-business owner, he’s on the front lines of the American economy, and what he’s seeing scares him.
As lawmakers have stalled on extending tax credits for people who get health insurance through the ACA, Volk is already seeing ripple effects. As marketplace plan premiums are set to spike, so too are prices for the private insurance that Volk offers his employees. He’s grappling with how to deal with price increases between 25 and 35 percent.
He also fears that as marketplace plans get more expensive without these tax credits, fewer people will give up employer-sponsored health insurance to start their own small businesses—something he says he was able to do only because of affordable marketplace insurance.
Arianna Freels, a stylist and magazine owner in Severn, Maryland, turned 26 last July—an American milestone that usually marks a person’s ineligibility to remain on their parents’ health insurance.
So Freels sought out her own plan on Maryland’s health insurance marketplace. Tax credits keep her monthly premium at roughly $60, and the plan she was auto-enrolled in for next year carries a similar price tag. But she fears how that might change if lawmakers allow these tax credits to expire at the end of the year.
“If things are going up, that plan is easily $500 a month,” she says.
Amber Gustafson, a writer and nonprofit fundraiser in Ankeny, Iowa, doesn’t qualify for ACA subsidies. But she’s still bracing for impact if lawmakers let them expire at the end of the year.
“I want them to continue to subsidize the plans of other people,” Gustafson says, “because the more people that are part of the ACA, the more cost-effective it is for everybody.”
Before the ACA was passed, Gustafson struggled to access the care her family needed under private health insurance. The law changed that, and it also changed how she voted. A lifelong Republican up to the 2008 presidential election, Gustafson changed her party affiliation and watched with frustration as GOP lawmakers opposed passing the ACA.
Gustafson is a degree removed from lawmakers’ current fight over extending tax credits for people on marketplace plans—she doesn’t qualify for the credits, and she faces a smaller monthly premium increase next year than many other marketplace enrollees. Still, she says Republicans’ constant threats to her marketplace coverage cause stress. And after watching her family enter poverty during the 1980s farm crisis, she knows how quickly stability can give way to financial uncertainty.
“You want these robust safety net systems in order to protect you,” she says.
