MARY LOUISE KELLY, HOST:
Health insurance premiums are set to skyrocket for millions of Americans on January 1. That is because the House of Representatives is getting ready to leave Washington for the holidays without voting on a bill to extend enhanced subsidies for Affordable Care Act plans. The Senate already failed to pass a bill on that last week. NPR's Selena Simmons-Duffin is here to tell us what it all means. Hey, Selena.
SELENA SIMMONS-DUFFIN, BYLINE: Hi, Mary Louise.
KELLY: I guess the first thing it means is January 1 premiums are going up for a lot of people.
SIMMONS-DUFFIN: Yeah. Yeah, so on average, premium costs are doubling for people who are enrolled in these Affordable Care Act plans on January 1. That is an average, so some people are looking at the same or lower premium costs, depending on a lot of things - their age, where they live, what kind of plan they're shopping for. Other people are seeing their premiums increase by $1,000 a month or more. The hardest-hit people are those whose income is high enough that they don't qualify for any subsidies anymore. So that's about $63,000 a year for an individual. Also, seniors are really hard hit. Their plans tend to be more expensive since older people need more health care. So retirees who aren't yet 65 and don't yet qualify for Medicare are hard hit in this, too.
KELLY: You just said some of this depends on where people live. Explain.
SIMMONS-DUFFIN: Yeah. I mean, part of it is just where people live and what states really use these plans a lot. And actually, that tends to be Republican states. And that's because there are 10 red states that didn't expand Medicaid to all low-income adults, which was another way the Affordable Care Act tried to reduce the number of people without insurance. So these plans are really popular in those states. The big ones are Texas, Florida, Georgia. Enrollment in Obamacare plans in Texas has tripled in just the last few years. The nonpartisan health research organization KFF crunched the numbers and found that 3 out of every 4 people enrolled in these plans live in states that President Trump won in the 2024 election.
KELLY: Well, that's interesting. Why were Republican lawmakers so resistant on this then?
SIMMONS-DUFFIN: Well, partly Republicans don't like the Affordable Care Act, and they don't want to vote to shore it up. They say the enhanced subsidies are just papering over the high cost of health insurance. Also, they say that it's a really small portion of the population that relies on these plans - only about 7% of Americans. Most people get their insurance through their jobs or through Medicaid or Medicare. So Republicans seem to be making the calculation that even if some of their voters are on the hook for these higher premiums, it might not be enough to hurt the party politically.
KELLY: And I understand there's a petition, a petition that would force Congress to take this up in the new year.
SIMMONS-DUFFIN: Right. Well, today, several House Republicans joined a discharge position - petition from Democrats to get it to the magic 218-signature threshold that would force a vote on a three-year extension of the enhanced subsidies, but that likely won't come up for a vote until January because of some scheduling rules. And then it would have to pass the Senate, and the Senate voted down a three-year extension last week, so it's not clear if it could become law. And it also would be messy logistically to change things in the new year since people will have already paid for the first month of coverage, and open enrollment only goes until January 15. So we'll have to wait and see how it all shakes out.
KELLY: In just a sentence or two, Selena, what can people do if they can't afford their premiums?
SIMMONS-DUFFIN: I mean, these marketplaces are already the option of last resort for people that - who don't get insurance through their work, so millions are projected to go uninsured if they can't afford their premiums.
KELLY: NPR's Selena Simmons-Duffin, thanks.
SIMMONS-DUFFIN: You're welcome. Transcript provided by NPR, Copyright NPR.
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