Locals to feel impact if healthcare credits expire

Allie Browning, the 28-year-old owner of downtown's Volume 2 Hair Studio and Barbershop, will see her monthly health insurance premium more than triple, from $85 to $285, for the same plan if federal healthcare subsidies remain unrestored.

Because Browning has multiple sclerosis, she can't go without. The specialty medication Ponvory allows her to see, walk and use her hands — but priced a step below chemotherapy, it's prohibitively expensive, and insurance plans that would let her live normally are difficult to find. It's where the Affordable Care Act comes in — offering certain protections, essential health benefits and out-of-pocket max payments for those who don't get insurance through their employer, Medicaid or Medicare.

"I just have to pay it and tough it out," said Browning, who like 48% of ACA plan recipients is a small business owner, employee or self employed, according to the Kaiser Family Foundation.

A surge in ACA plan premiums caused by the credits' expiration has raised concern among individuals and families about how they'll afford to live, said Priscilla Easterling — one of Kentucky's health insurance navigators for the ACA healthcare marketplace, kynect, and a director at the advocacy nonprofit Kentucky Voices for Health. The marketplace enrollment is trending down, the Cabinet for Health and Family Services told the Daily News, as data has shown increases in the number of cancellations and downgraded healthcare plans.

Some 92,000 Kentuckians have used these plans this year, according to the Kentucky Cabinet for Health and Family Services. Warren County has 3,977 residents this year, or 2.7% of its population, who access them, according to Kentucky Health Benefit Exchange data published by the nonprofit Kentucky Center for Economic Policy.

The surges in ACA plan costs stem from the Dec. 31 expiration of what are called enhanced Advanced Premium Tax Credits (APTCs) — funding helping people afford these plans, set by 2021 COVID relief legislation and temporarily extended in 2022 to supplement existing healthcare credits. Congress is slated to vote on the legislation for these enhanced APTCs this week, with Republicans anticipated to vote it down — as House Speaker Mike Johnson has reportedly said that most House Republicans oppose it. Opponents have described the credits as an enormous cost intended as temporary, susceptible to fraud, wasteful when supporting people who are wealthier, and inefficiently spent toward insurance companies; they cost about $35 billion annually, according to the Congressional Budget Office — about 2% of the roughly $1.7 trillion the U.S. spends annually on discretionary programs.

The legislation extending the credits through the year's end lowers the maximum amount anyone can pay for premiums; offers the option of certain $0 health plans to those earning 100% to 150% of the poverty level; and extends the credits to those earning more than 400% of the poverty level for those plans if they would exceed 8.5% of household income, according to the Kentucky Center for Economic Policy.

The expiration separately contributes to an additional surge in the monthly premiums. This year across the kynect plans, Anthem increased premiums for individuals on average by 24%, Molina increased them 16.3% and Wellcare increased them by 37%, according to the companies' rate filings.

These increases in part stem from an expectation that younger adults will disproportionately forgo coverage due to having less need than others — which means insurance companies anticipate needing to cover customers who, more than before, are older, sicker and more likely to cost them money, according to Easterling and Dustin Pugel, policy director at the Kentucky Center for Economic Policy.

Pugel, who reviewed the filings, said the surge is mainly due to the credits' expiration and the Trump administration's undoing of marketplace flexibility provisions, as well as — to a lesser degree — One Big Beautiful Bill Act measures that will make it more difficult to qualify for coverage. The latter two factors are anticipated to shrink the pool of people contributing to insurance companies' plans — causing the companies to increase premiums, Pugel said.

More than four-fifths of Kentuckians on these plans — about 75,000 residents — received letters at the beginning of this open enrollment period informing them that their health insurance premiums would increase by about $100 or more per month, Pugel and Easterling said separately, citing Kentucky Cabinet for Health and Family Services data.

Nearly 10,000 are seeing a premium increase of $500 or more, Easterling added, citing the Cabinet.

As of Monday, around 82,000 individuals have signed up for a marketplace plan, with more than a tenth canceling their plans or downgrading from silver plans to bronze plans. About 5,300 have canceled, while most of 7,300 Kentuckians who changed their plans did the latter, according to the Cabinet.

Those who cancel may seek insurance elsewhere, but whether they do is unknown, Pugel said. Easterling and Emily Beauregard, the head of Kentucky Voices for Health, expressed worry that the higher prices are encouraging people to opt for what are effectively junk or scam healthcare plans that, unlike ACA plans, typically require medical information disclosure in applications and run a high risk of coverage shortcomings and loopholes in benefits and consumer protections, according to Easterling.

Affordability

One of the families Easterling assisted had budgeted to cut back on food for the first half of each month so they could afford healthcare, she said. Another family will spend toward health insurance for one family member who has a heart condition, rather than all of them — opting to pay for the other family members' diabetes medications and mental health needs out of pocket. Circumstances depend on families and their health needs — and in some cases, people can't afford the increase, she said.

Megan Wingfield, a Scottsville caregiver for her mother in law, anticipates needing to go without. This past year, the advanced credits covered $680 for Wingfield and her partner — about the same as their rent. A portion of that would go with the expiration, and the two are still figuring out what they'll do then.

"We're not disillusioned by the fact we're going to be well outside of affordability when it does expire," she said. "Personally, I don't know anybody who can afford to pay that much for health insurance on top of rent, utilities, gas for work, other expenses for life.

It's a shame that people have to forgo their healthcare in order to be able to afford to live."

Overall, while cancellations so far have indicated a decrease, there aren't as many as previous national estimates had suggested, Pugel said. But, from his perspective, this indicates how badly people need health insurance.

"I think that really plays into the broader concerns about affordability right now. People have to have health insurance: If you're diabetic, you don't have a choice. If you're in the middle of chemotherapy, you don't have a choice," Pugel said. "When people are paying more for health insurance every month, they have less for everything else."

County marketplace data

A nonsmoking Warren County family with Kentucky's median demographics would average paying 122% higher in premiums — $216 more monthly — for the ACA plan the U.S. government uses to establish the minimum standards for essential health benefits, according to county-specific marketplace data. (The median Kentucky household comprises a 12-year-old girl with two 39-year-old adults who earn $61,118, according to the U.S. Census Bureau's American Community Survey.)

Louisville Public Radio data reporter Justin Hicks retrieved the data to calculate how much the expiration would cost hypothetical families. The costs in Warren County largely align with the state's.

The biggest impact concerned a 22-year-old single female making $25,000, who would pay an average of over six times more than this year — a 637% surge in Warren County, from $13.33 to $98.25.

A 60-year-old couple making $85,000 — just above 400% of the poverty level — would average a 352% increase, from $602 to $2,723 countywide.

Fifty-year-old parents who earn $100,000 with three teenage kids would pay 83% more, from $410 to $748 in Warren County.

If her husband didn't recently get his current job offer, Bowling Green resident Holly Hudnall would have seen their family plan's premium roughly quadruple to around $2,000.

Hudnall, whose employer doesn't offer health insurance, said her family has gone without coverage since July after her husband was laid off. As she sought plans on the Kentucky marketplace, a plan similar to her husband's, which had a $450 premium, was to cost $100 more without the enhanced credits.

However, her husband got a job offer at a similar income but no benefits for the first six months — and their premium shot up to around $2,000 for a worse plan. Because Hudnall and her husband have chronic conditions, it wouldn't be enough, she said.

They had planned to solely insure her husband so he could get the medication needed for his heart condition. But Hudnall, who is diabetic, would have had to rely on medications that treat her diabetes far less effectively and cause worse side effects — and medical costs would have still eaten them alive, she said.

Her husband has since been offered benefits through his contract as a computer programmer, with a $900 family plan. It completely changed their family's health outlook and financial future — but there's still fear he may lose his job, and fear for others, she said.

"… I have to be grateful, at least for now, that this is the outcome," she said. "It also makes me feel guilty because many people in our position are working as much as they can work, and still are not going to be able to afford insurance without more subsidies …

"I don't know what the answer is, or what our Congress needs to do, but I know that people can't afford this. I know that people will go uninsured. I know they will rack up medical debt that they won't ever be able to pay off and they will forgo care that they need because of how much it costs. We certainly would have."