The Boston Globe
The lives of millions could be dramatically changed by what Congress does next.
For hundreds of thousands of people across Massachusetts, the fight at the center of the government shutdown carries frightening and immediate consequences: Can they continue to afford government-backed health insurance, or will they face skyrocketing premiums that could shatter their financial security?
Since 2021, expanded federal subsidies have made it possible for 337,000 people in Massachusetts to more easily afford health insurance through the Massachusetts Health Connector, the state’s version of the Affordable Care Act marketplace.
Democrats want to make the subsidies, which are due to expire at the end of the year, permanent.
Republicans have proposed a one-year extension but say the government must be funded before they would negotiate further. The Congressional Budget Office reported last month that making the expansion permanent would add $350 billion to the national deficit through 2035 but would increase the number of Americans with health insurance by 3.8 million.
The lives of millions could be dramatically changed by what Congress does next. If the subsidies expire, some will be entirely excluded from buying coverage through the exchange. And the vast majority of the 24 million people enrolled in the Affordable Care Act marketplace will see some increase in their monthly premiums.
While it’s not clear yet how much more each person could pay, the average increase for a consumer in Masssachusetts could be $1,300 a year, according to the state Health Connector. And depending on which policy they buy, many could face much larger increases.
Judith O’Gara, a part-time editor at community newspapers, and her husband, self-employed as a computer animator and mural artist, pay about $450 a month for a subsidized insurance plan through the Connector. That’s about $800 less a month than they used to pay.
“We’re not big spenders, we live a fairly frugal life,” said O’Gara, 56, of Millis. “The anxiety that paying such a large bill for health insurance brings on is immense.”
Policies bought through the marketplaces are designed for people who make too much to qualify for Medicaid but would still struggle to afford coverage in the open market. Many are self-employed, work at a small business, or live in rural areas where insurance is more pricey. Some can buy health insurance through their employer but found less expensive coverage through the marketplace.
In Boston, Charles Senties, 43, a nurse’s assistant at a city hospital, is not sure how he’ll manage if his insurance premiums increase. This past year, he paid about $300 a month for insurance.
If his premiums increase significantly, he’s not sure whether he could afford them. And going without insurance isn’t an option, Senties said. He has cardiovascular issues and severe carpal tunnel syndrome. The cost of the care he received this year would probably exceed his annual income if he didn’t have insurance coverage, he said.
“I do hope the Democrats do hold up and stand their ground, because they need to do something about what’s going on,” Senties said.
The number of people insured through the marketplaces nationally doubled, the health policy analysis organization KFF reported, after the 2021 expansion that made subsidies more generous and extended them for the first time to some people making between 400 and 500 percent of the federal poverty level, about $133,000 for a family of three.
“It’s really hard to overstate how impactful it was,” said Audrey Morse Gasteier, executive director of the Connector. “It provided relief for a lot of people who had to make really hard decisions between affording health care and rent, or affording health care and child care.”
Morse Gasteier noted the clock is ticking: Open enrollment for the coming year’s insurance coverage begins in less than a month.
Christa, 55, is a hair dresser who needs the subsidized health insurance for coverage that her employer doesn’t offer. With the subsidized plan, Christa’s premiums dropped from $932 a month in 2023 to $282 this year.
She and her husband, Gary, 69, a truck driver enrolled in Medicare, combined earn less than $78,000 annually or about 485 percent of the poverty level. If Congress doesn’t renew expanded subsidies, they will no longer qualify for the exchange along with other families and individuals earning near that 500 percent limit of the poverty line. The Berkshire County couple, who asked that their last names not be used to protect their privacy, said if their insurance costs return to where they had been, home improvements, car repairs, and travel would become difficult to afford.
“We’re going to end up dipping into our savings,” Gary said. “We don’t know where this is all going to end.”
KFF in August estimated that between 34,000 and 57,000 more people in Massachusetts would likely go without insurance due to Obamacare changes.
Massachusetts mandates that residents have coverage and penalizes those who don’t; someone earning between 400 and 500 percent of the federal poverty level could be fined $132 a month for not having coverage.
“We are fighting to help American families hang onto their health insurance because no one should go bankrupt because they got sick and needed to see a doctor,” said Massachusetts Senator Elizabeth Warren, a Democrat, in a floor speech last week.
The Cato Institute, a right-leaning policy think tank, described the health coverage subsidies as a response to the temporary emergency created by the COVID pandemic and stated they are too generous and too expensive to sustain. Some of the people eligible under the expansion don’t really need the help, the institute concluded.
The White House has insisted Democrats first must agree to a deal to reopen the government, “and then we can have all the important policy discussions needed,“ said spokesperson Abigail Jackson.
Allowing the subsidy to expire would cause ACA insurance premiums to more than double nationwide, KFF has reported, and would have ripple effects throughout the health care system. Their loss, coupled with the anticipated reduction of people on Medicaid due to restrictions in President Trump’s signature domestic spending bill passed earlier this year, is expected to result in longer emergency room waits and less money going into the health care system.
“That will translate to layoffs and office closures and ultimately longer wait times and longer drives for health care services for all of us,” said Kaitlyn Kenney Walsh, vice president of policy and research at the Blue Cross Blue Shield of Massachusetts Foundation, a nonpartisan health policy analyst. “The impacts here collectively really can’t be understated.”
Young, healthy people are more likely to try to go without insurance, making the pool of insured people in the state on average older and sicker and increase premium costs for everyone.
For O’Gara and her family, it wasn’t so long ago that their monthly health care premiums left them perpetually scrambling.
“When we were paying the higher insurance it just took away from what we were paying for electricity, for oil,” she said. “We’d always have a remaining balance.”
In anticipation of premium increases, O’Gara is considering working more hours with the hope she can qualify for an employer-supported policy, and has even considered foregoing comprehensive coverage in favor of a catastrophic insurance policy, which has low premiums but very high deductibles.
“I hope that Congress decides to extend this,” she said. “I truly believe it should be a bipartisan issue.”
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