'Punishing': Alaska small-business owners consider next steps amid steep rises in health care costs

Nov. 16—Thousands of Alaskans who purchase insurance through the Affordable Care Act marketplace will see their premiums skyrocket without the extension of subsidies that are set to expire at the end of the year.

The expiration of the enhanced premium tax credits could cripple small businesses in Alaska, some owners say, as they face premiums that in some cases will triple year over year, eating away at their ability to keep their businesses afloat.

"We're working tooth and nail every day to make our way so we don't have to rely on any help and assistance," said Brie Loidolt, who owns a bookkeeping business in Anchorage and is facing an increase of hundreds of dollars per month in her premium costs.

Congress is "just punishing us for being small-business owners," said Loidolt, who has weighed closing her business in response to the rise in health insurance costs.

Extension of the tax credits was a top priority for Senate Democrats during the longest government shutdown in U.S. history. But the shutdown ended Wednesday with no deal to extend the health care subsidies or provide any other measure to lower the cost of health care.

Congress now has until the end of the year to extend the credits — which were enacted in 2022 — or watch them expire.

Alaska's U.S. Sen. Lisa Murkowski has said she supports the extension of the tax credits, at least in the short term, to avoid the projected sharp price increase. U.S. Sen. Dan Sullivan has also said he supports an extension of the subsidies. Alaska's U.S. Rep. Nick Begich has not spoken in favor of their extension or responded to multiple interview requests on the subject.

The agreement to end the shutdown included a promise from the Senate majority leader to hold a vote on a proposal to extend the tax credits before the end of the year, but Alaskans are already being asked to make decisions about their 2026 coverage. For them, action from Congress can't come soon enough.

"I need my government, specifically my congressional delegation, to speak for me concerning the levers of power in this country, and I feel absolutely abandoned," said Mark Robokoff, who owns a pet supply shop in Anchorage and is staring down a more than 300% increase in the cost of insurance.

The impact of the elimination of the tax credits depends on the income, age and family size of the enrollee. Premium increases are greatest for Alaskans nearing retirement age who earn 401% of the poverty line or higher.

Of the roughly 25,000 Alaskans enrolled in plans purchased through the Affordable Care Act marketplace, many of those who will see the sharpest increase in insurance costs are owners of small businesses who say their contributions to the Alaska economy are on the line.

'An entirely new calculus'

Robokoff said the monthly insurance premium for him and his partner is set to triple, going from $924 in 2025 to $2,886.

"This will pull the rug out from under me," said Robokoff. "I thought I was doing the things that a society wants its members to do — create new businesses, create new jobs, improve the life of the surrounding community."

Robokoff said that when he was younger, he went without insurance, but he now relies on medication that would cost thousands of dollars a month without insurance, so forgoing coverage is not an option.

Given the increase in the price of premiums, he said he will have to consider what changes to make in the business.

"It's an entirely new calculus. Everything is going to have to be looked at, from the prices I pay for merchandise, the quality that I try to stock, the amount that I pay my employees to keep the best ones — every single aspect of the store is going to have to be re-examined," he said.

Robokoff said his mindset so far has been a "fingers-crossed hope that Congress would not put us in this ridiculous situation." He thought, "our situation is so drastic that the government can't help but come to our aid."

"That hope and surety is rapidly being stripped away," he said, as lawmakers have repeatedly punted on an extension.

'Cut us at the knees'

Loidolt, who owns an accounting firm that employs four people, said her insurance premiums are set to go up roughly $500 per month, or $6,000 for the year, without the subsidies.

She already pays $1,347 per month in premiums. Without the extension of the subsidies, she'll be paying more per month for her health insurance than she spends on her mortgage.

"Who can afford to live when 30% of everything you bring in just pays for insurance and deductible?" Loidolt said.

Loidolt said she has tried to purchase a company plan for her business, but she learned that insurance companies largely don't offer plans to companies in Alaska with fewer than five participating employees.

"So our hands are kind of tied there, too. It's not like we have options and we're choosing this more expensive option through the marketplace," she said.

Loidolt recently suffered an accident that has left her with ongoing medical needs that would cost thousands of dollars a month without insurance. Going without insurance is not on the table, she said.

Given rising health care costs, Loidolt said she is considering shutting down her business, laying off her employees and ending the accounting services she provides to roughly 40 small businesses.

Loidolt said she thinks she could get a salaried job that comes with benefits, but closing her business would be "heartbreaking" and devastating for her clients.

"I feel like we're part of the solution, and this is going to make us part of the problem," she said. "We're the people that are actually paying our bills every month. We're not on assistance. We're making it work, even with these ridiculous prices. We're offering jobs with small companies. We're offering competition to people so that the monopolies don't take over. And they're just going to cut us at the knees."

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'It makes me want to throw up'

Nan Schleusner, a human resources consultant in Anchorage, said she and her husband — who are both sole proprietors — have relied on insurance purchased through the Affordable Care Act since the enhanced premium tax credits kicked in.

The tax credits made marketplace plans affordable for them for the first time, just as Schleusner and her husband were getting older and encountering more health concerns.

"Thank God" they got the insurance, Schleusner said, because in 2022, she was diagnosed with cancer.

"It was really wonderful when the enhanced premium tax credits took effect, because it helped with these extreme medical bills that we ended up having," she said. "It was just that peace of mind, like, OK, it's still a stretch — it's not inexpensive — but we can do it."

But now, Schleusner is facing $37,000 in annual premium payments and a $15,000 deductible for her family of three, for the cheapest plan on offer.

Schleusner said she is considering reaching out to some of the companies she consults for and asking to become their employee so she can join their insurance plan.

"I've been doing this 15 years, and I feel called to do it," she said. "So I don't want to give it up. It's been some sleepless nights."

Schleusner this year paid $1,380 per month for her family of three, or $16,560 in premiums for the year. To keep the same plan she currently has next year, she'd pay more than 300% of this year's cost, with premiums totaling over $52,000 annually.

"It makes me want to throw up every time I look at it," she said.

"There's the affordability part, but there's the 'what on Earth is going on that this is costing $50,000 a year?' That's not a reasonable cost," she said.

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