A MARTÍNEZ, HOST:
Millions of Americans will be able to start shopping for health insurance on Saturday, and some of them might not like what they'll see. The average monthly premium for the roughly 24 million people who get their coverage through the Affordable Care Act marketplaces are expected to more than double. That's unless Congress extends subsidies that have been helping people pay for coverage. They were created in 2021 during the pandemic and eventually extended through this year. Democrats are hoping that people seeing much higher rates and then being vocal about them will convince Republicans to extend the subsidies quickly.
Now, that standoff is what's behind the current government shutdown. Coming up, we'll talk to one of the architects of the Affordable Care Act about why the law was passed in the first place and what issues he sees with the ACA that still need to be fixed. But we'll start with the changes this weekend. Sarah Boden is a health reporter in Pittsburgh. She's been following this. So, Sarah, the predictions are that the average premium is going to more than double. Do we know who might be hit the hardest?
SARAH BODEN: So it really depends on where you live and how much you earn. For people who earn more than 400% of the federal poverty level, they're likely to see the biggest jumps. For example, let's say you and your spouse - you're both 60 years old and bring in a combined $85,000 a year, which is just over that 400% threshold. That means their subsidies will disappear in 2026 if nothing changes. This past year, a couple like that paid $600 a month for mid-level coverage, which is, like, known as the silver plan. Without the subsidies, that price tag shoots way up. Health policy think tank KFF did an analysis. It shows that if that couple lives in Pittsburgh, their premium will increase to more than $2,000 a month starting next year.
MARTÍNEZ: OK. Sounds like pretty big jumps. Is that going to be the way it's going to be everywhere - it's going to be high everywhere?
BODEN: In some places, it's going to be even higher. Health insurance rates vary by location, and these subsidies won't be there to help. For example, if that same couple lives in Wheeling, West Virginia, which is just an hour from Pittsburgh, KFF estimates that a silver plan will cost them $4,200 come January.
MARTÍNEZ: A month?
BODEN: Yes, a month. And rates are going to go up for people who have lower incomes as well. These subsidies also help them. Now, their price increases might not be as extreme, but they'll feel it in their wallets.
MARTÍNEZ: Do you think people will pay this much to get health care coverage?
BODEN: A lot of Americans are still waiting to see their final rates. I spoke with Devon Trolley. She's the head of the insurance marketplace here in Pennsylvania, and she's worried that people won't renew their coverage.
DEVON TROLLEY: With these higher prices, what we'll really be looking at is how many of our current enrollees are making the difficult decision to drop coverage. And are we getting any new enrollees in, or are they really pushed away by the cost as well?
MARTÍNEZ: So, Sarah, I mean, how long will we have to wait to see whether people are signing up?
BODEN: Trolley says that, in her experience, people who already have coverage through the marketplace tend to sign up at the start of open enrollment. These are folks who will be most aware of premium increases because they can compare their new 2026 rates to what they currently pay. So I'm guessing we'll hear pretty soon from folks if they're upset about the prices or have sticker shock. We're talking about real estate agents, manicurists, farmers. KFF found these people - that they're going to be more likely to be self-employed and to rely on insurance from the marketplace. It's going to be interesting to see how members of Congress react, and I'll be watching to see if they change their positions on ACA subsidies and if this might break the stalemate in Congress and end the government shutdown.
MARTÍNEZ: All right. That's reporter Sarah Boden in Pittsburgh. Thank you for talking through the subsidies with us.
BODEN: My pleasure. Transcript provided by NPR, Copyright NPR.
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