JUANA SUMMERS, HOST:
The country is about a month into a government shutdown with the Affordable Care Act, also known as Obamacare, still at the center of the fight. Democrats are still holding out for a deal to extend the tax credits that help people pay for health care through the ACA exchanges, warning that without those subsidies, health care costs would skyrocket for tens of millions of people, people like Lynn Chernin (ph) from Tampa, Florida.
LYNN CHERNIN: I had emergency gallbladder surgery, and I got a bill from the hospital for $85,000.
SUMMERS: She got that bill while she was still on a private insurance plan, and she later switched to an ACA plan she's really happy with.
CHERNIN: It's significantly better. I mean, the premiums are great. The copays are amazing. You know, it's - I feel very, very lucky.
SUMMERS: Same goes for Chernin's friend and former colleague Laura Reynolds (ph), who also got on Obamacare this year.
LAURA REYNOLDS: Amazingly enough, it almost seems to cover better medication than my own insurance I was paying almost a thousand dollars a month for.
SUMMERS: Yesterday, both women were able to get a look at their estimated costs for next year on the exchanges. And for Chernin...
CHERNIN: My insurance premium would only be going up about a dollar a month.
SUMMERS: Reynolds, on the other hand, was shown an estimated premium of more than $450 a month. That is a huge jump because right now, she has a $0 premium. But she says it's still doable in light of what she used to pay before Obamacare.
REYNOLDS: Because it's still less money than I was paying out of pocket through my own company that I was working for.
SUMMERS: But there's still frustration for Reynolds, not due to costs but the political fight over those costs. Her stepdaughter, a government worker, has been affected by the shutdown, a shutdown that persists as Democrats say they're fighting to keep health care more affordable for millions like her.
REYNOLDS: It is very upsetting that the one thing that is shutting our government down right now is the fact that they're arguing over health care. You know, when you're talking millions and millions of people who are on marketplace, and then you have this small group of people who are determining our health and our future.
SUMMERS: Cynthia Cox conducts research on the Affordable Care Act for KFF, a health information nonprofit, and she's here to break down where things stand. Welcome.
CYNTHIA COX: Hi. Thanks for having me.
SUMMERS: Now, I know that KFF's research leading up to this week estimated that, on average, most Americans would see what they're paying for their ACA health insurance more than double. The exact number was a 114% jump, again, on average. Now, in the past day of, quote-unquote, "window shopping," is there any reason to believe that most people won't really see huge jumps in what they pay? I know that we heard from one person in Florida who told us that their costs are really not going up by all that much.
COX: So these premiums are really based on a formula. What someone pays is a certain percent of their income. So for the vast majority of people who get a tax credit, it's actually really easy to figure out how much more they're going to have to pay. So really, our estimate holds true that what people will pay will more than double, on average. Of course, that's going to vary from person to person. Some people may not see much of a premium increase. Other people could see astronomical premium increases. But really, you know, I think the reality is that on average, people's costs are going to double.
There are some things that people can do to mitigate those costs. You know, there might be a way to switch a plan. For example, instead of getting a silver plan, someone might be able to get a bronze plan, which would have a lower premium, but it would have a much higher deductible. And so there certainly are trade-offs that people will have to consider.
SUMMERS: Cynthia, I mean, it's unclear what will happen on Capitol Hill, but even if lawmakers do find a way to end the shutdown, they come up with another plan to extend Obamacare tax credits into next year, at this point, with no plan in place, is the damage sort of already done? Can people still hold out hope for some sort of deal to extend subsidies?
COX: The longer this goes on, the more damage there could be. You know, what the concern is from an insurer's perspective is that people are logging on now and shopping for plans, and they're going to see these big premium increases, and that might be enough to scare them away. You know, that might be enough for them to just drop their health coverage. So that's what - health insurers are concerned that the healthier or younger people are going to be the ones that drop their coverage, and then they'll be left with a sicker average group of people who are signing up, meaning that their costs are higher and premiums have to go up even more.
And also, you know, just from a perspective of, you know, if you want more people to have insurance, then you want them to have, you know, full information of what their plans are actually going to be, you know, how much their costs are going to be for next year. At the same time, though, there's still time for Congress to make a change if they do decide to extend the tax credits. Although people are able to shop right now, the tax credits do not actually expire until the end of the calendar year. So if Congress were to act before December 31, then the enhanced tax credits could still go into effect in January.
SUMMERS: So say you're a person who's out there beginning to shop for ACA marketplace insurance next year. What advice would you give them right now?
COX: If it were me, I would honestly wait a few weeks to shop. There still is some possibility that there could be a deal made, and probably shopping over the Thanksgiving holiday is fine. You know, that should give you enough time to, you know, look at your options and sign up for coverage. It's probably a good idea to decide on what your health plan is going to be before December 15 so that you can lock that plan in to start January 1. Usually, that's when you have to make a decision for coverage that starts January 1. But if you wait a couple more weeks, you should still have enough time to sign up.
That being said, if you think you're going to need someone to help you through the process, like an insurance agent or broker or a health insurance navigator, then start trying to make that contact and those appointments now because these folks are going to be very busy this year.
SUMMERS: Cynthia Cox, vice president and director of the program on the Affordable Care Act for the nonprofit KFF. Thank you so much.
COX: Thank you. Transcript provided by NPR, Copyright NPR.
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