This week, despite a last-ditch effort by some House Republicans to strike a deal on health care, Congress remains deadlocked on whether to extend support for millions of Americans who get their health care through the Affordable Care Act.Margot Sanger-Katz, who covers health care policy, explains who will be most affected by the decision.Then, we hear directly from some of the Americans who will now face a decision: whether to keep paying for rising insurance costs or to risk going without it.Guest: Margot Sanger-Katz, a reporter for The New York Times who covers health care policy and government spending.Background reading: Four Republicans joined Democrats’ bid to force a vote on health subsidies.Obamacare users will be asked to pay more for plans that cover less.Photo: Eric Lee for The New York TimesFor more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify. You can also subscribe via your favorite podcast app here https://www.nytimes.com/activate-access/audio?source=podcatcher. For more podcasts and narrated articles, download The New York Times app at nytimes.com/app.
Chapter 1: What is the main topic discussed in this episode?
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I don't really pray much, but I pray at night that something happens, that I wake up in the morning and I check the news and that the subsidy was extended. Something that will make it not $55,000 next year. Something.
This week, despite a last-ditch effort by some House Republicans to strike a deal on health care, Capitol Hill remains deadlocked on whether to extend support for millions of Americans who get their health care through the Affordable Care Act.
Without the subsidies, it would be the minimum of $1,500 a month, and there wasn't no way. My original estimate was about a 1,200% increase. I think I was in tears the entire rest of the week after I got that news.
That's left those Americans to confront a wrenching decision. I asked my husband, like, what should we do?
He's like, maybe we go without health insurance.
And I was like, oh my God, no way. Keep paying for rising insurance costs or risk going without it.
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Chapter 2: What is the current status of health care subsidies in Congress?
And I think they're worried about political consequences when the midterms roll around. So there's been this kind of deal-making debate between some of these moderate Republicans and Democrats. Could they form a compromise? Could they pass something that would patch the subsidies and that other Republicans could sign on to?
But the deadline for enrollment came on Monday, and they did not pass anything like that.
So this is the open enrollment that we're all quite familiar with at this point from the Affordable Care Act.
Yeah. I mean, you probably have the same thing for like we have the same thing here at the Times for our work insurance. There's some period of time in which you have to pick and pay for your health insurance. And that signs you up for the whole year. And there just are deadlines that happen every year.
So even though we're not at the end of the year now, we're kind of a little bit at the end of the line for these subsidies. People had to make their choices. Right. Now, that said, it may not be totally over. This week, something kind of unusual happened.
A couple of moderate Republicans who are really mad at the speaker of the House for not giving them a chance to vote on this joined up with all of the Democrats to sign what's called a discharge petition, which is a way to get a bill on the floor without the House speaker's cooperation. And that bill would extend the subsidies for three years. Mm hmm.
But that bill isn't going to come up for a vote for probably a couple of weeks. And it's not clear whether it can pass the Senate. So for now, it looks like these subsidies are going to expire and a lot of people are going to have to pay more for their health insurance.
So the key word that we have been using a lot here is subsidies. But I want to make sure that people actually understand what that means. Specifically, what were the subsidies and how are they changing?
So if you will indulge me, I think it makes sense to go back in time a little bit and talk about Obamacare. Definitely. So when Democrats passed the Affordable Care Act in 2010, they set up a system where people who don't get their insurance through work or through a government program have access to a market. And if they make less than 400 percent of the federal poverty level—
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Chapter 3: Who will be most affected by the expiration of health care subsidies?
And at first, they made it really short term. But then they immediately saw that tons more people were signing up for coverage.
Do we know who was really driving that surge? What kind of people? What kind of income level?
Almost all of this growth is coming from that bottom income category. So those are the people that are eligible for these $0 premiums. I think there are a couple of reasons why that happened. One is just that's a group that's much more likely to be uninsured. If you think about the kinds of jobs that low-income people have, they're just much less likely to come with health insurance.
You know, if there's someone who has a bunch of gig economy jobs that they're patching together or a part-time job, those are the kinds of jobs generally don't have health insurance. And so those people are really benefiting from the ability to go get a free plan somewhere else. It's also like free is a really important horizon, it turns out.
Even asking people to pay a small amount can really discourage them and particularly low income people from enrolling in these kind of programs. A lot of really low income people don't even have a bank account. And so if you just imagine the mechanics of like, how is that person going to pay a monthly premium? They can't write a check. They don't have a credit card.
Not impossible, but makes it harder.
What did Republicans think of all these changes to the Obamacare subsidies?
Well, I think it's important to remember Republicans never liked Obamacare. They felt like it was a waste of money. They thought it was putting too many rules on the health insurance system. And this was a huge expansion. It's a lot more dollars. It was bringing more people into the system. And I think they also objected to some of the specific policy changes.
They really didn't like the idea that all these people were going to get insurance for free. It felt sort of unfair to them. Everyone else has to pay something for health insurance. And I think a lot of Republican lawmakers feel like,
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Chapter 4: What changes have occurred in health care subsidies since the Affordable Care Act?
Today's episode was produced by Anna Foley, Olivia Natt, Stella Tan, and Diana Nguyen, with reporting from Anna Foley. It was edited by Rob Zipko. Contains music by Diane Wong, Alicia Baitube, Marion Lozano, and Pat McCusker. And was engineered by Alyssa Moxley. That's it for The Daily. I'm Rachel Abrams. See you tomorrow.