AILSA CHANG, HOST:
We don't know when the federal government shutdown will end, but we do know that we are on Day 22, and we know that the central policy disagreement is about health insurance.
ADRIAN FLORIDO, HOST:
At the end of the year, enhanced pandemic-era tax credits that help people pay for insurance plans are set to expire. These plans, known as Obamacare plans, are sold through the state or federal marketplaces created by the Affordable Care Act. And if these enhanced subsidies go away, millions of people will have to pay a lot more.
CHANG: So Democrats want to force Congress to pass an extension of the expanded tax credits. Republicans say, no, fund the government first, and then we can negotiate later. The NPR Politics Podcast broke this down recently. Host Deepa Shivaram spoke with our congressional correspondent, Barbara Sprunt, and our health policy correspondent, Selena Simmons-Duffin, who we hear from first.
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SELENA SIMMONS-DUFFIN: What the federal government did when they set up these marketplaces in the first place, they said, OK, we're going to cover some of your monthly costs so that you can actually afford this plan so you can get covered. And it kind of worked for a while. Like, 11 million, 12 million people would sign up for these plans. But in 2021, when they enhanced these subsidies, the federal government started kicking in much more of the cost of the monthly premium, which meant that people were like, oh, actually, this is a good deal.
The uninsured rate went to the lowest level it's ever been in American history. The number of people in these plans ballooned to 24 million. And these are small business owners. They are small business employees. This is, like, the only option for people in these professions where employer-based insurance is not available.
DEEPA SHIVARAM: So, Barbara, I mean, the people that Selena is talking about here, some of them live in places represented by Republicans in Congress, right? How are those lawmakers responding to the idea that some of their constituents might lose these subsidies?
BARBARA SPRUNT: These are really popular. You know, in polling, voters across the political spectrum support Congress extending these credits. There is a political reality here that you're getting at, though, which is 3 of the 4 enrollees live in states that President Trump won last year. But importantly, these are very expensive. You know, the subsidies keep the costs down for consumers, but the flip side is that they cost the government a lot of money.
The Congressional Budget Office, it's nonpartisan. It estimates that it would cost $350 billion over the next decade if those enhanced credits were expanded permanently. Republicans argue these credits were meant to be temporary, put in place, you know, during the COVID pandemic. That price tag is going to make it extremely difficult to get a bipartisan deal on adjusting these. This only happens with a bipartisan deal because of the numbers on the Hill.
SHIVARAM: Well, Selena, what is the impact here if these subsidies do go away at the end of the year?
SIMMONS-DUFFIN: Well, it's going to mean that people's costs that they pay every month for their health insurance premiums are going to skyrocket. The average increase is over 100%. So you're getting the same plan you paid for last year, but you're paying double. I talked to one woman in West Virginia who's paying 3- or $400 a month now, and she's looking at a monthly premium of $2,800.
SHIVARAM: Whoa. That's a big difference.
SIMMONS-DUFFIN: For some people, depending on age and income and state and all of these other factors, it's unworkable for them. So the Congressional Budget Office did an analysis of what this will mean in terms of people dropping health insurance and estimated that 4 million people will become uninsured if these enhanced credits aren't extended, and that's over the next 10 years. Basically, it's really big trouble for this whole section of how Americans get health insurance, and there's no question that if these enhanced subsidies go away, it's going to have an enormous impact on people.
SHIVARAM: Well, you're talking about what a big impact this is and how much it'll affect particularly the people who won't be insured anymore. How much is the public paying attention to this? Is there any sense that this is something that people are really worried about?
SIMMONS-DUFFIN: Yeah. I mean, November 1 is a really key date because that is when open enrollment starts in these plans. And I think once people start logging on and, like, kind of doing this annoying routine thing that you do every fall to try to figure out what insurance you're going to get...
SHIVARAM: Yeah.
SIMMONS-DUFFIN: ...When they see the numbers that they're going to be asked to pay for these plans, I think you're going to have a huge new wave of awareness in the public that this is happening.
CHANG: That was NPR's Selena Simmons-Duffin and Barbara Sprunt speaking with Deepa Shivaram on the NPR Politics Podcast. You can listen to the NPR Politics Podcast every day on the NPR app or wherever you get your podcasts. Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
