By Lori Lee
NDG Contributing Writer
In January, millions of Americans will wake up to a new year, with government letters explaining their insurance is going up, some health premiums doubling, others nearly tripling, explained former Executive Director of Health Access California Anthony Wright, speaking at an October American Community Media briefing. People, on average, will pay about $700-800 a year or 18% more on average, while 50- and 60-year olds and certain income brackets will see steeper increases, up to thousands.
About 70% of those polled indicate they’ll no longer be able to afford coverage, added Ashley Kirzinger, director of survey methodology and associate director of the Public Opinion and Survey Research Program at KFF. Speaking at the briefing, she said healthcare is a huge cost for Americans, ranking above monthly utilities, food and groceries, even rents and mortgages. This is especially true for lower income workers and farmers, as well as Black and Hispanic adults, all being more likely to report having problems paying for healthcare.
It was a long road to get American healthcare where it is today. Barack Obama, inspired by his mother’s illness, paved a path toward improved coverage, though it is very expensive compared to other nations who have universal coverage, KFF reported. Yet, the 2010 Affordable Care Act (ACA) has allowed millions of Americans to have a better life. In addition to reducing race and ethnicity coverage disparities, it has meant earlier diagnoses and reduced deaths from cardiovascular disease, certain cancers and maternal mortality, National Institutes of Health reported.
Australia, Sweden, the Netherlands, Japan. and a number of European countries provide universal coverage, and because everyone in these countries has access to preventative medicine, their costs are much lower compared to the American system. Higher service and drug prices hold up American health expenditures, and the complexity of a system with multiple insurers creates higher administrative costs, they report.
Since now, we’ll be reducing the number of insured rather than expanding coverage to more Americans, private insurers are already planning for a smaller, sicker risk pool, meaning premiums will increase for everyone, a KFF study predicting increases of 18% next year.
Medicaid eligibility was expanded for ACA and preexisting condition denials prohibited in 2014, while in 2021, premiums were reduced and coverage expanded through the premium enhanced tax credit set to expire this December. The credits guaranteed no one would pay over 8.5% of their income, said Wright.
Jennifer Sullivan, who leads the Center for Budget and Policy Priorities Beyond the Basics project, said 93% of marketplace enrollees have the premium tax credits. Starting in 2021, Americans saw huge gains in enrollment among people of color due to the credits, increasing coverage by 186% for Black people and 158% for Latinos, though undocumented immigrants have never qualified for marketplace coverage. Recent regulations have even sharply reduced eligibility for legal immigrants, including DACA recipients, which had just received coverage this January, she said.
The ACA cuts will compound the effects of future cuts to Medicaid set out in HR 1, combining to further hurt nursing homes and maternity wards who rely on Medicaid in high-cost urban and especially rural areas.
With about half of Americans insured through their employers, small business owners, contract workers and low-income workers will feel the pain, added Wright. It will also remove the safety net for those between jobs or wanting to start a business.
The changes will be catastrophic for many, said Sullivan, while some can lessen the pain by choosing a lower tier plan with a higher deductible and a lower premium.
Without the extension, much of the public wont be able to afford care, 40% reporting they’ll go without coverage in 2026. Many will defer and delay care until it becomes urgent, turning to community clinics and emergency rooms, added Kirzinger. If left unpaid, costs will increase for everyone.
“This means we are not providing care at the front end, but only in the most expensive, most inefficient way possible, which is at the emergency room on the back end, added Wright, and that creates a ripple effect through the healthcare system that we all rely on.”
Only about 4 in 10 have heard about the cuts, with a slight uptick in public awareness after the government shutdown. This includes those who buy coverage on the marketplace, added Kirzinger. Yet, the public says they would support extension of the credits, including 92% of Democrats, 82% of Independents, and 59% of Republicans. This is one area where people have agreement. There are not very many issues that have bipartisan support, said Kirzinger.
This may be a time when we can utilize our agency and call members of Congress to urge their support, Wright urged.
