1
00:00:01,835 --> 00:00:05,072
I'm Steven Potter for "Here&
Now".

2
00:00:05,639 --> 00:00:08,542
>> In health care news.
Affordable Care Act premiums

3
00:00:08,609 --> 00:00:11,945
are expected to increase
sharply when people enroll,

4
00:00:12,012 --> 00:00:15,215
starting in November.
Insurance companies are

5
00:00:15,282 --> 00:00:19,753
making their projections now
for 2026. Rates in

6
00:00:20,687 --> 00:00:24,124
Wisconsin, nearly 850,000
people are enrolled in ACA

7
00:00:24,191 --> 00:00:27,895
plans. 12 insurers across
the state that offer

8
00:00:27,961 --> 00:00:33,300
marketplace plans, project
increases ranging from 6.6%

9
00:00:33,934 --> 00:00:37,070
to 34.5%, according to
Health system analysts.

10
00:00:37,137 --> 00:00:40,807
What's driving this
increase? We turn to

11
00:00:40,874 --> 00:00:43,710
Caroline Gomez-Tom, an
enrollment manager with the

12
00:00:43,777 --> 00:00:46,880
covering Wisconsin program,
which helps people sign up

13
00:00:46,947 --> 00:00:49,850
for marketplace plans. And
thanks very much for being

14
00:00:49,917 --> 00:00:51,585
here.
Frederica.

15
00:00:52,319 --> 00:00:55,088
>> So when you saw these
projected premium hikes,

16
00:00:55,155 --> 00:00:59,927
what was your reaction,
especially to the like 34.5%

17
00:00:59,993 --> 00:01:03,564
increase?
>> Yeah, it was definitely a

18
00:01:05,265 --> 00:01:08,802
startling hike. Except we
weren't necessarily

19
00:01:08,869 --> 00:01:12,573
surprised knowing that there
were some things that were

20
00:01:12,639 --> 00:01:16,076
in the mix regarding
enhanced premium tax credits

21
00:01:16,143 --> 00:01:19,379
that were going away or
potentially going away. You

22
00:01:19,446 --> 00:01:22,749
know, Congress could still
act in, you know, these

23
00:01:22,816 --> 00:01:26,086
several months before the
end of the year and then

24
00:01:26,153 --> 00:01:29,256
some other policy changes
that have happened at the

25
00:01:29,323 --> 00:01:34,094
federal level. Plus
healthcare costs, rising

26
00:01:34,161 --> 00:01:38,832
inflation, etc, that could
be a part of this. But to

27
00:01:40,067 --> 00:01:43,303
see the numbers that we are
expecting for this year, it

28
00:01:43,370 --> 00:01:46,373
it took it took your breath
away.

29
00:01:47,741 --> 00:01:52,412
>> Yeah. So these enhanced
tax credits are due to

30
00:01:52,479 --> 00:01:57,217
expire at the end of 2025.
How did those tax credits

31
00:01:57,284 --> 00:02:00,287
help with out-of-pocket
costs?

32
00:02:01,188 --> 00:02:04,758
>> Yeah. So these extended
tax credits, they have been

33
00:02:04,825 --> 00:02:09,963
in place now since 2020. And
essentially they expanded

34
00:02:10,531 --> 00:02:16,136
really the discounts or the
amount that people qualified

35
00:02:16,203 --> 00:02:19,006
for to lower their cost of
insurance, especially for

36
00:02:19,072 --> 00:02:22,609
those folks that had
slightly higher incomes. So

37
00:02:22,676 --> 00:02:26,313
that middle income range
above 400% of the federal

38
00:02:26,380 --> 00:02:30,918
poverty level. And what that
means is that people had

39
00:02:30,984 --> 00:02:33,720
more options to consider
when they were looking at

40
00:02:33,787 --> 00:02:37,658
the healthcare.gov options,
instead of just going

41
00:02:37,724 --> 00:02:41,728
directly to the lowest cost
bronze plan with a crazy out

42
00:02:41,795 --> 00:02:45,566
of pocket cost for an
individual, they could

43
00:02:45,632 --> 00:02:48,268
actually shop around
realistically and look at

44
00:02:48,335 --> 00:02:52,906
the plan that may cost a
little more per month, but

45
00:02:52,973 --> 00:02:55,475
because of those extended
premiums, they could afford

46
00:02:55,542 --> 00:02:59,379
it, but had also lower out
of pocket costs for them.

47
00:02:59,446 --> 00:03:03,417
>> And so did those premium
tax credits. Encourage a lot

48
00:03:03,483 --> 00:03:06,486
more people to actually
enroll?

49
00:03:08,222 --> 00:03:11,592
>> Absolutely. And we could
see that even just this last

50
00:03:11,658 --> 00:03:14,828
year where we hit a
milestone year in enrollment

51
00:03:14,895 --> 00:03:18,966
in Wisconsin, we had 313,000
people sign up, which was

52
00:03:19,032 --> 00:03:22,503
the highest we'd seen since
the marketplace opened in

53
00:03:22,569 --> 00:03:25,038
2014.
>> So according to an

54
00:03:25,539 --> 00:03:28,675
analysis that we read, there
are other drivers other than

55
00:03:28,742 --> 00:03:32,513
these enhanced tax credits
of rate hikes, like the cost

56
00:03:32,579 --> 00:03:35,649
of health care itself, which
you mentioned, including

57
00:03:35,716 --> 00:03:40,487
specialty drugs like
Ozempic. What's it like for

58
00:03:40,554 --> 00:03:45,125
people with ACA plans to see
such swings in costs?

59
00:03:46,560 --> 00:03:51,164
>> Yeah, I think it's tough
because we're already

60
00:03:51,231 --> 00:03:54,801
talking about folks who
otherwise don't have access

61
00:03:54,868 --> 00:03:58,338
to another form of coverage.
These are folks that don't

62
00:03:58,405 --> 00:04:00,541
qualify for Medicaid. They
usually do not have an

63
00:04:00,607 --> 00:04:03,143
option for health insurance
through their employer. So

64
00:04:03,210 --> 00:04:06,046
they're already going to
healthcare.gov because there

65
00:04:06,113 --> 00:04:09,783
are limited options for
them. And then without this

66
00:04:09,850 --> 00:04:12,452
additional financial
assistance to help lower the

67
00:04:12,519 --> 00:04:15,622
cost of insurance. And sure,
there still will be some tax

68
00:04:15,689 --> 00:04:18,959
credits for most folks, but
there still will be some

69
00:04:19,026 --> 00:04:23,263
that really will get priced
out of the marketplace. And

70
00:04:23,330 --> 00:04:26,333
that I, you know, that's
that's very difficult for

71
00:04:26,400 --> 00:04:29,203
folks to go without health
coverage.

72
00:04:29,269 --> 00:04:32,306
>> So if someone is
enrolling or Re-enrolling

73
00:04:32,372 --> 00:04:35,609
for next year, what is your
advice?

74
00:04:36,810 --> 00:04:40,948
>> Well, I would say to
start early, get connected

75
00:04:41,014 --> 00:04:44,284
with a health insurance
navigator. Covering

76
00:04:44,351 --> 00:04:46,486
Wisconsin still has our
navigator program and we

77
00:04:46,553 --> 00:04:49,790
will help people sign up for
coverage through

78
00:04:49,857 --> 00:04:53,861
healthcare.gov. They can
call 211. They can also

79
00:04:53,927 --> 00:04:57,598
reach us directly on
discover.com or our website,

80
00:04:57,664 --> 00:05:00,234
covering Wisconsin. To sign
up for an appointment. And

81
00:05:00,300 --> 00:05:03,270
they need to shop around.
And I normally would say

82
00:05:03,337 --> 00:05:05,739
they should shop around, but
really this year I think

83
00:05:05,806 --> 00:05:08,642
it's a need to make sure
that they understand all the

84
00:05:08,709 --> 00:05:11,345
options that are available
to them so that they can

85
00:05:11,411 --> 00:05:15,349
make a sound choice, because
what I don't want to see are

86
00:05:15,415 --> 00:05:19,186
people just foregoing even
going to healthcare.gov

87
00:05:19,253 --> 00:05:21,555
because they're deterred by
cost. We want people to at

88
00:05:21,622 --> 00:05:24,024
least know what their
options are so they can make

89
00:05:24,091 --> 00:05:27,427
a sound decision.
a sound decision.