LOCAL FAMILIES FACE AFFORDABLE CARE ACT STICKER SHOCK PREMIUMS SET TO DOUBLE, TRIPLE IF CONGRESS FAILS TO EXTEND SUBSIDIES

A rural Dane County family's experience illustrates the way thousands across Wisconsin will be affected by skyrocketing health care costs if Congress does not fund expanded subsidies for insurance plans under the Affordable Care Act.

Rachel LaCasse-Ford and her husband and two children live in Black Earth, a close-knit community of fewer than 2,000 people. Lacasse-Ford chose to live there for the rural setting and the ability for her to run her own business, a local campground a few hours away near the Mississippi River.

For years, she said, she's felt secure in supporting her family and making sure her children are healthy and cared for. As a small business owner, she and her husband bought their health insurance through the federal marketplace as part of former President Barack Obama's Affordable Care Act, and her two children have been covered by BadgerCare.

Now, as the government shutdown continues and Congress remains in a partisan stalemate over the health care subsidies, LaCasse-Ford fears some of their monthly insurance costs will more than double.

She's one of more than 300,000 state residents who have health insurance through the federal marketplace. New data from the Wisconsin Office of the Commissioner of Insurance shows nearly 280,000 could see the monthly cost of their health care drastically increase if members of Congress don't extend a series of subsidies that keep individual costs low.

LaCasse-Ford was previously the CEO of the Mount Horeb Chamber of Commerce while her husband was a stay-at-home father and managed the campground. She and her husband, Chris, regularly discussed how her income would affect their health insurance options. The couple faced a catch-22 that millions of Americans also experience - how to make enough for their family to live comfortably but not so much that their children no longer qualify for BadgerCare.

"I can't seek out jobs that pay too highly, yeah, because it will send us over a cliff," she said. "I just think there has to be a better way. Incentivize people to be active contributors to our economy rather than stifling us."

That those conversations are so common doesn't make sense to LaCasse-Ford.

Her daughter, Elinor, is 6 and her son, Owen, is 13. BadgerCare, the state's Medicaid program, covered the births of both children.

Over the years, though, LaCasse-Ford suffered four miscarriages and wasn't far enough along in her pregnancies for BadgerCare to cover her care after the losses.

So, she said, while working through the emotional pain that came with each miscarriage, she also had to pay for that medical care out of pocket.

"What a system," she said. "My most expensive pregnancies didn't result in any children, which is just crazy. I just feel like that point in your life when you're trying to grow your family, and you're trying to navigate this crazy system, it just feels like they're not supporting you."

LaCasse-Ford is starting a new job soon that will provide health insurance for her and her children. She will still pay for the plan, but through her new employer. That insurance won't cover her husband, though, and he will still need to rely on the Affordable Care Act.

Chris has a preexisting condition and must have a plan that covers his medication. That means he has to find an insurance plan that covers the prescription, and that almost always means a higher premium.

"He really couldn't be uninsured," LaCasse-Ford said. "So that is really scary."

Without the premium tax credits, she anticipates his health insurance will cost as much as the plan for her and her two children combined.

For years, the couple chose the high-deductible plans in order to secure a more affordable monthly premium. In recent years it's cost the two about $300 a month. Without the tax credits, that monthly cost would more than double to around $800.

The expanded tax credits had saved the family enough that LaCasse-Ford and her husband were able to create a comfortable savings account. If health care costs go up for her husband, those higher monthly premium payments will quickly eat through the family's savings, she said.

"All of the unknowns are very stressful," she said.

How did we get here?

The Affordable Care Act became law in 2010 under President Obama.

The framework for premium tax credits for Affordable Care Act health plans began in 2014. Since then, the federal government capped how much plan holders pay for their insurance premiums, limiting the cost at a certain percentage of their annual income. The government would pay for the rest by providing a tax credit to make up the difference.

In 2021, amid the COVID-19 pandemic, Congress and President Joe Biden expanded the premium tax credits to entice more Americans to be insured. The plan worked: The number of people with health insurance ballooned from around 11 million to over 24 million people.

Without the enhanced tax credits, some plan holders will see their insurance costs double or triple.

For example, according to the nonprofit health research nonprofit KFF, a family of four with an annual income of $55,000 a year previously paid about $462 annually for a standard health plan. Without the enhanced tax credits, that annual cost would increase to more than $2,800.

The subsidies remain at the center of stiff partisan debate in Congress, lengthening the government shutdown. Open enrollment, when many will select health plans for the next year, began Saturday, Nov. 1.

Sample premium costs

The Cap Times experimented to see what it would cost someone living in Madison to get an Affordable Care Act insurance plan without the enhanced tax premiums.

For a 35-year-old single woman who requires no prescriptions and makes about $60,000 a year, a plan with the lowest premium would cost:

$311 a month with a deductible of $8,000 and an additional out-of-pocket maximum amount of $10,600.

And a plan with the lowest deductible would cost:

$556 a month with a deductible of $0 and an out-of-pocket maximum of $3,300.