Older Texans facing steep hikes for ACA

Of all the topics 55-year-old Groves resident Theresa Hebert has discussed on her TikTok account @foolish_mortal999 over the past five years, nothing has brought in new viewers like her recent anxiety over expected Affordable Care Act health insurance price hikes. Not even her battle with breast cancer.

"With the current government shutdown and the threat of not extending the subsidies for the Affordable Care Act, I'm a bit worried," she told viewers last month.

Her plan costs $581 a month and it's helped cover four surgeries, 16 rounds of chemotherapy and 30 days of radiation this past year. Her plan is made somewhat affordable after receiving $250 a month in subsidies enacted under the Biden administration.

But those subsidies that have helped bring down the cost of monthly premiums for ACA plans, also called enhanced premium tax credits, are set to expire at the end of the year. Starting next year, Hebert's monthly premium will rise 88% to $1,091, just slightly less than her $1,400 monthly mortgage.

"It's not ideal," said Hebert, whose job as a property manager doesn't offer health benefits.

Higher risk, higher cost

Texans over the age of 45 are among those statewide who are seeing the highest rise in their premiums this open enrollment, which closes Jan. 15, according to health policy experts.

More than one-fourth of the state's 4 million ACA enrollees are between the ages of 45 and 64.

For a 60-year-old Texas couple with a total income of $85,000, the Center on Budget and Policy Priorities estimates enhanced tax credits would have capped their annual premium for a silver plan at $7,225, but that would jump to $33,689 if the enhanced subsidies expire.

On Oct. 1, the federal government shut down after Republicans and Democrats failed to pass a bill funding government services from that day forward. Although Republicans hold a majority of seats in both chambers of Congress, they were short the votes in the Senate needed to pass the spending bill. For more than a month, Democrats would not sign on unless the tax credits were extended. But on Nov. 10, the Senate passed a spending plan, 60-40, without the ACA tax credits extension, as the Democrats had once demanded.

Without those subsidies, many ACA plan consumers are feeling forced to either find a way to pay for their more expensive existing plans, sign up for a less expensive plan with higher deductibles or forgo insurance entirely and hope that they remain in good health. On average, Texas insurers have increased ACA premiums by 35%, but for older ACA enrollees who already pay more, the hikes are even higher.

"So price impacts tend to hit older folks the hardest," said Laura Dague, who is the James M. Griffin professor of health policy at Texas A&M University.

The reason is simply the higher amount of health problems older individuals experience.

"In general, they're higher risk," Dague said. "That means that insurance companies have to charge them more."

Older enrollees, especially those in their 50s and early 60s have been stunned to see whopping hikes in their premiums.

As she's had to repeatedly explain to younger TikTok viewers who tell her to "just go on Medicare," Herbert has 10 more years before she would be eligible for the cheaper, government-sponsored plan for those Americans who are 65 and older.

For now, she's struggling with the news as she weighs her options.

There are cheaper ACA plans that still cost around $700 a month, but they could provide less coverage and force her to pay more out of pocket before the plan starts to cover more services. If she changes plans, she may not keep her current doctors. When asked what she intends to do before open enrollment ends Jan. 15, all Hebert can say is: "I have no idea. I have no clue."

For the most part, older Texans are willing to pay the higher ACA prices because the only other option is to be uninsured. The tough part for Hebert and Texans like her is now coming up with so much more money to keep their coverage going. If they go with a cheaper plan, they worry if they will have vital prescriptions covered or whether they'll be forced to restart their health care with new providers or those who are located farther away.

From $0 to $870 a month

This year, subsidies reduced the monthly price of G.W. Babb's plan from $860 to zero. Next year, the 63-year-old Austin graphic designer's insurance company will raise its rate to $1,270, and he will lose about half of the subsidies he received. As a result, he'll go from paying nothing to paying $870 a month for health coverage.

To make his situation worse, Babb's doctor of the past 20 years is not in the network of this new plan.

So Babb said he will have to pay $150 per visit out of pocket to continue seeing this provider on top of the $870 monthly premium.

"Going from paying nothing to paying nearly $900 a month is insane," Babb said. "Even without all the subsidies, it's still $400 a month more than what I'm paying right now."

Hebert and Babb were hoping the tax credits would be extended as part of the federal shutdown negotiations.

Hebert said news that SNAP federal food assistance was first on hold, then delayed for November because of the federal shutdown weighed on her.

"I don't want people to go hungry. But I also, I need for, I really need for the subsidies to be extended," she said.

She's stunned by how little some of her younger TikTok audience and the more privileged older ones understand how the federal government operates and how they see the tax credits as some sort of something-for-nothing welfare grab.

"Please forgive me for the whopping $250 in subsidies that I've received for the past 14 months even though I've never received literally any form of assistance in any aspect of my life," she clapped back at her viewers recently, reminding them she's paid taxes for 40 years.

Talking health care boosts audience

The engagement on her account has boosted viewership. As anguished as her story has been, the tension over the rising cost of health care, told in real time through social media, is resonating with both supporters and detractors. It's helped her to get closer to the 10,000 followers she needs to get paid by the app for her content. She sardonically muses that may be one way to help her stay with her current insurance plan.

"Come for me more, please" she told her viewers earlier this month. "The more you guys do that ... and I'm going to get to 10K (followers) and then I'm going to be able to get monetized ... and then you won't have to hear me complain about how (expletive) expensive my health insurance is."

About a week later, she'd reached 10,200 followers.

Dan Keemahill contributed to this report.

The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans about public policy, politics, government and statewide issues.