Celia Monreal is constantly worried about the health of her husband Jorge, who suffers from knee osteoarthritis. But their concern is not just because Jorge is in pain, but because the Monreal family, like millions of Americans, could soon face their healthcare costs rising dramatically.
And Celia and Jorge Monreal depend on health insurance contracted through the Affordable Health Act (nicknamed Obamacare), which offers a subsidy through a tax credit that is about to expire. If Congress does not extend it, the Monreals will no longer be able to afford the insurance, and without it they will not be able to pay for the surgery that Jorge needs for her knees, much less other types of treatments, such as the medications she takes for hypertension.
“It does worry me, because if you are not healthy you cannot take good care of your children or other things,” says Celia Monreal. “There is no choice but to make difficult decisions: Do I spend $500 on a doctor’s appointment or buy what we need from the supermarket?”
“If there are fewer subsidies for people who have health insurance, then there is less coverage (…) There will be more sicknesses and deaths.”
jason levitis public health researcher
Being confronted with decisions like these could become increasingly common for million people in the United States who must renew their health insurance this November contracted through the state or federal Affordable Care Act (ACA) marketplace.
The tax credits offered to low- and middle-income families have made it possible for them to contract health insurance. But If Congress does not extend the credits, the average price of the policies are going to double, according to an analysis by KFF, a health research organization.
The future of tax credits for health insurance is one of the issues at the center of the partisan disputes that have led to the current government shutdown, which has been going on for more than two weeks without a quick solution appearing feasible.
Democratic lawmakers are demanding that any budget package to reopen the government must include an extension to subsidies for these health coverages, while Republicans say this issue should be discussed until after there is a temporary budget.
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Since there is no agreement and the re-enrollment period for ACA plans is approaching, which in almost all states is November 1, American people like the Monreals feel in limbo.
114% increase
More than 24 million people they have health insurance through the ACA market. That group includes small business owners, farmers, ranchers and many people who cannot obtain health insurance through their employment.
Tax credit subsidies have helped most of them afford health insurance, to the point that some low-income people do not have to make monthly premium payments.
Direct or out-of-pocket spending (called out of pocket in English) to have the policies, on the other hand, would increase up to 114% by 2026, costing on average 1,016 dollarsaccording to KFF analysis.
Some subsidies will still exist, but they will only be available to people earning less than $63,000 a year (an amount equal to about 40% of the poverty line).
As a result, many more middle-income people will have to pay much more for health insurance, without access to subsidies, and low-income people will also have to pay more, although not as much as the first group, according to Cynthia Cox, program director for Obamacare issues at KFF.
That will make several people have to stop taking out health insuranceaccording to Cox. When that happens, the companies that sell the policies usually increase the price of premiums for those who still have coverage to compensate.
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Hospitals will also be affected, because there will be more people who need the medical care provided there but do not have insurance to pay for it.
“If there are fewer subsidies for people who have health insurance, then there is less health coverage and less health care,” warns Jason Levitis, senior researcher for public health at the Urban Institute. “More people will get sick and die.”
They expect to fall into bankruptcy
There are many people like the Monreals. Among them is Erin Jackson-Hill, who suffers from asthma and deep hip pain that she manages with prescription drugs so she can access prosthetic surgery.
If the ACA subsidies expire, Jackson-Hill is certain she will no longer be able to afford any health insurance. At the moment You already pay $500 a month in premiums; The increase would make it impossible to afford the policy. In that case, you are wondering what you will have to do if your hip problem worsens.
“I guess I’ll try to go to the ER and go bankrupt so I can pay for it,” says the woman, who lives in Anchorage, Alaska, and runs a nonprofit organization.
Chrissy Meehan is in a similar situation. Meehan, who works as a hairstylist in Pennsylvania, has a neck problem for which she has been told she needs surgery. He says that if the ACA subsidies expire he will have to postpone that intervention even more even though he needs it.
Meehan, 51, voted for Donald Trump last year. Now she says she regrets it, given that Republicans are the ones who have pushed for cuts to Medicaid and have not wanted to renew subsidies for the health coverage she depends on.
“I work hard, I’m trying to stay afloat and do everything the right way,” Meehan says. “I don’t want to be given things for free, I just want what is offered to be affordable for people with incomes like mine.”
Chaos and confusion two weeks before deadline
Public health researchers point out that, even if Congress ends up extending subsidies, at this point in the year many health insurance companies have already established rates and policies for 2026 that will be more expensive due to the possible expiration of tax credits.
Some people have already started receiving notices that premiums will increase because of this starting November 1, even if the increase is not as much as 114% on average.
“As soon as those people also say, ‘No way, I can’t do it anymore, I’m canceling it,’ it’s going to be very difficult to get them to have health insurance again,” says Levitis of the Urban Institute.
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Faced with all these possibilities, there is a lot of chaos, stress and confusion among ordinary people.
This is the case of the Monreals. Jorge probably needs prostheses on both of his knees, after which he would have to stop working for a while since his job is in the construction sector. Achieving a budget for your home, which with both Jorge and Celia’s income is around $45,000 annually, will become much more difficult.
Two weeks before the ACA re-registration period, all these fears have only accumulated.
“We don’t know anything about them,” says Celia about the health insurance company and the policies she would have as of November 1. “And in the end that’s how you end up without medical care.”
