I'm Steven Potter for "Here& Now".
>> In health care news. Affordable Care Act premiums
are expected to increase sharply when people enroll,
starting in November. Insurance companies are
making their projections now for 2026. Rates in
Wisconsin, nearly 850,000 people are enrolled in ACA
plans. 12 insurers across the state that offer
marketplace plans, project increases ranging from 6.6%
to 34.5%, according to Health system analysts.
What's driving this increase? We turn to
Caroline Gomez-Tom, an enrollment manager with the
covering Wisconsin program, which helps people sign up
for marketplace plans. And thanks very much for being
here. Frederica.
>> So when you saw these projected premium hikes,
what was your reaction, especially to the like 34.5%
increase? >> Yeah, it was definitely a
startling hike. Except we weren't necessarily
surprised knowing that there were some things that were
in the mix regarding enhanced premium tax credits
that were going away or potentially going away. You
know, Congress could still act in, you know, these
several months before the end of the year and then
some other policy changes that have happened at the
federal level. Plus healthcare costs, rising
inflation, etc, that could be a part of this. But to
see the numbers that we are expecting for this year, it
it took it took your breath away.
>> Yeah. So these enhanced tax credits are due to
expire at the end of 2025. How did those tax credits
help with out-of-pocket costs?
>> Yeah. So these extended tax credits, they have been
in place now since 2020. And essentially they expanded
really the discounts or the amount that people qualified
for to lower their cost of insurance, especially for
those folks that had slightly higher incomes. So
that middle income range above 400% of the federal
poverty level. And what that means is that people had
more options to consider when they were looking at
the healthcare.gov options, instead of just going
directly to the lowest cost bronze plan with a crazy out
of pocket cost for an individual, they could
actually shop around realistically and look at
the plan that may cost a little more per month, but
because of those extended premiums, they could afford
it, but had also lower out of pocket costs for them.
>> And so did those premium tax credits. Encourage a lot
more people to actually enroll?
>> Absolutely. And we could see that even just this last
year where we hit a milestone year in enrollment
in Wisconsin, we had 313,000 people sign up, which was
the highest we'd seen since the marketplace opened in
2014. >> So according to an
analysis that we read, there are other drivers other than
these enhanced tax credits of rate hikes, like the cost
of health care itself, which you mentioned, including
specialty drugs like Ozempic. What's it like for
people with ACA plans to see such swings in costs?
>> Yeah, I think it's tough because we're already
talking about folks who otherwise don't have access
to another form of coverage. These are folks that don't
qualify for Medicaid. They usually do not have an
option for health insurance through their employer. So
they're already going to healthcare.gov because there
are limited options for them. And then without this
additional financial assistance to help lower the
cost of insurance. And sure, there still will be some tax
credits for most folks, but there still will be some
that really will get priced out of the marketplace. And
that I, you know, that's that's very difficult for
folks to go without health coverage.
>> So if someone is enrolling or Re-enrolling
for next year, what is your advice?
>> Well, I would say to start early, get connected
with a health insurance navigator. Covering
Wisconsin still has our navigator program and we
will help people sign up for coverage through
healthcare.gov. They can call 211. They can also
reach us directly on discover.com or our website,
covering Wisconsin. To sign up for an appointment. And
they need to shop around. And I normally would say
they should shop around, but really this year I think
it's a need to make sure that they understand all the
options that are available to them so that they can
make a sound choice, because what I don't want to see are
people just foregoing even going to healthcare.gov
because they're deterred by cost. We want people to at
least know what their options are so they can make
a sound decision. a sound decision.