Health insurance is at the center of the government shutdown battle : NPR

AILSA CHANG, HOST:

We don’t know when the federal government shutdown will end, but we do know that it is day 22 and the central policy disagreement is over health insurance.

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At the end of the year, pandemic-enhanced tax credits that help people pay for their insurance plans are set to expire. These plans, known as Obamacare plans, are sold on state or federal marketplaces created by the Affordable Care Act. And if these increased subsidies disappear, millions of people will have to pay much more.

CHANG: So Democrats want to force Congress to pass an extension of the expanded tax credits. The Republicans say no, we have to fund the government first, and then we can negotiate later. The NPR Politics podcast recently explained this. Host Deepa Shivaram spoke with our Congressional Correspondent, Barbara Sprunt, and our Health Policy Correspondent, Selena Simmons-Duffin, from whom we hear from the former.

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SELENA SIMMONS-DUFFIN: What the federal government did when they created these marketplaces in the first place was they said, OK, we’re going to cover a portion of your monthly costs so that you can actually afford this plan and be covered. And it worked for a while. Like, 11 million, 12 million people would sign up for these plans. But in 2021, when it increased those subsidies, the federal government started taking on a much larger share of the cost of the monthly premium, which meant people were like, oh, actually, that’s a good deal.

The uninsured rate has reached its lowest level ever in American history. The number of people benefiting from these projects has increased to 24 million. And they are small business owners. They are employees of small businesses. It is somewhat the only option for people in these professions for whom employer insurance is not available.

DEEPA SHIVARAM: So, Barbara, I mean, the people that Selena’s talking about here, some of them live in places that are represented by Republicans in Congress, right? How do these legislators react to the idea that some of their constituents could lose these subsidies?

BARBARA SPRUNT: These are really popular. You know, in polls, voters across the political spectrum support Congress to extend these credits. There is, however, a political reality that you are alluding to here, which is that 3 of the 4 registrants live in states that President Trump won last year. But above all, these products are very expensive. You know, subsidies reduce costs for consumers, but the flip side is that they cost the government a lot of money.

The Congressional Budget Office is nonpartisan. He estimates it would cost $350 billion over the next decade if these enhanced credits were extended permanently. Republicans argue that these credits were supposed to be temporary, put in place, you know, during the COVID pandemic. This price tag will make it extremely difficult to reach bipartisan agreement on adjusting these items. This only happens with bipartisan agreement because of the number of Members on the Hill.

SHIVARAM: Well, Selena, what would be the impact if these subsidies disappeared at the end of the year?

SIMMONS-DUFFIN: Well, that’s going to mean that the costs that people pay every month for their health insurance premiums are going to skyrocket. The average increase is over 100%. So you get the same plan you paid for last year, but you pay double. I spoke to a woman in West Virginia who currently pays $3 or $400 a month and is looking at a monthly premium of $2,800.

SHIVARAM: Wow. That’s a big difference.

SIMMONS-DUFFIN: For some people, depending on their age, their income, their condition and all these other factors, it’s not feasible for them. So the Congressional Budget Office analyzed what this would mean in terms of abandoning health insurance and estimated that 4 million people would become uninsured if these enhanced credits are not extended over the next 10 years. Basically, this is a really big deal for this whole part of how Americans get health insurance, and there’s no doubt that if these enhanced subsidies go away, it’s going to have a huge impact on people.

SHIVARAM: Well, you talk about the significant impact that this represents and the extent to which it will particularly affect people who will no longer be insured. To what extent is the public paying attention to it? Is there a sense that this is something that people are really concerned about?

SIMMONS-DUFFIN: Yeah. I mean, November 1st is a really key date because that’s when open enrollment begins for these plans. And I think once people start going online and doing that boring routine that you do every fall trying 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.

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