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.
Twelve insurers across the state
that offer marketplace plans
project increases ranging
from 6.6 percent to
34.5 percent.
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.
Thanks for having me, 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, et cetera, that could be
a part of this.
To see the numbers that
we are expecting for this year.
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 income.
So with 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 costing 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 have.
Also lower out-of-pocket costs for
them, and then especially for those
higher-income folks, middle income
folks, they could enter
the marketplace probably for the
first time since
it existed and
and not have to depend on
other like short-term insurance type
plan options.
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 something
that really will get priced
out of the marketplace.
And that's
very difficult for folks to
go without health coverage.
Because also what happens to the
marketplace itself if people
don't enroll because they really
can no longer afford it.
Well, and this is something that we
saw, you
know, in the early years of
the marketplace where the health
systems were still trying to figure
out kind of where their sweet spot
was for pricing,
is that if not enough people were
signing up and joining and enrolling
in plans, then you end up
with the people that need health
insurance, like they have chronic
illness, they have conditions
that... You know need regular
health care and so then they'll
pay what they have to in order to
get the care that they need but then
healthier folks that still need
care that still could end up
and realistically may end up
in the emergency room because they
are without health insurance and
they've waited they
they will just hold off from signing
up for a plan just because they're
deterred by cost.
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
wiscovered.com or our website
coveringwi.org to
sign up 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
forgoing, 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 a
sound decision.
All right, great advice, Caroline
Gomez-Tom, thanks very much.
For more on this and other issues
facing Wisconsin, visit our website
at pbswisconsin.org and
then click on the news tab.
That's our program for tonight.
I'm Frederica Freyberg.
Have a good weekend.
Thank you.