Lynn Arditi: As health-insurance costs surge, families puzzle over options

“The Sick Girl", by Michael Ancher, 1882, in National Gallery of Denmark, a nation that has very good health care.

From Kaiser Family Foundation Health News (except image above). This article is part of a partnership between KFF Health News and National Public Radio.

PROVIDENCE

New York-based performer Cynthia Freeman, 61, has been trying to figure out how to keep the Affordable Care Act health plan that she and her husband depend on.

“If we didn’t have health issues, I’d just go back to where I was in my 40s and not have health insurance,” she said, “but we’re not in that position now.”

Freeman and her husband, Brad Lawrence, are freelancers who work in storytelling and podcasting.

In October, Lawrence, 52, got very sick, very fast.

“I knew I was in trouble,” he said. “I went into the emergency room, and I walked over to the desk, and I said, ‘Hi, I’ve gained 25 pounds in five days and I’m having trouble breathing and my chest hurts.’ And they stopped blinking.”

Doctors diagnosed him with kidney disease, and he was hospitalized for four days.

Now Lawrence has to take medication with an average cost without insurance of $760 a month.

In January, the cost of the couple’s current “silver” plan rose nearly 75 percent, to $801 a month.

To bring in extra cash, Freeman has picked up a part-time bartending gig.

Millions of middle-class Americans who have ACA health plans are facing soaring premium payments in 2026, without help from the enhanced subsidies that Congress failed to renew. Some are contemplating big life changes to deal with new rates that kicked in on Jan. 1.

It often falls to women to figure out a family’s insurance puzzle.

Women generally use more health care than men, in part because of their need for reproductive services, according to Elizabeth Tobin-Tyler, a professor at Brown University’s School of Public Health.

Women also tend to be the medical decision-makers for the family, she said, especially for the children.

“There’s a disproportionate role that women play in families around what we think of as the mental load,” said Tobin-Tyler, and that includes “making decisions around health insurance.”

Before the holidays, Congress considered a few forms of relief for the premium hikes, but nothing has materialized, and significant deadlines have already passed.

Going Uninsured?

As the clock ticked down on 2025, B. agonized over her family’s insurance options. She was looking for a full-time job with benefits, because the premium prices she was seeing for 2026 ACA plans were alarming.

In the meantime, she decided, she and her husband would drop coverage and insure only the kids. But it would be risky.

“My husband works with major tools all day,” she said, “so it feels like rolling the dice.”

NPR and KFF Health News are identifying B. by her middle initial because she believes that her insurance needs could affect her ongoing search for a job with health benefits.

The family lives in Providence. Her husband is a self-employed woodworker, and she worked full-time as a nonprofit manager before she lost her job last spring.

After she lost her job, she turned to the ACA marketplace. The family’s “gold” plan cost them nearly $2,000 a month in premiums.

It was a lot, and they dug into retirement savings to pay for it while B. kept looking for a new position.

Because Congress failed to extend enhanced subsidies for ACA plans, despite ongoing political battles and a lengthy government shutdown over the issue, B.’s family plan would have cost even more in 2026 — almost $3,000 a month.

“I don’t have an additional $900 lying around in my family budget to pay for this,” she said.

B. had already pulled $12,000 out of retirement funds to pay her family’s 2025 rates.

Unless she finds a new job soon, the family’s projected income for 2026 will be less than 266% of the federal poverty level. That means the children qualify for free coverage through Medicaid.

So B. decided to buy a plan on the ACA marketplace for herself and her husband, paying premiums of $1,200 a month.

“The bottom line is none of this is affordable,” she said, “so we’re going to be dipping into savings to pay for this.”

Postponing a Wedding

The prospect of soaring insurance premiums put a pause on Nicole Benisch’s plans to get married.

Benisch, 45, owns a holistic wellness business in Providence. She paid $108 a month for a zero-deductible “silver” plan on Rhode Island’s insurance exchange.

But the cost in 2026 more than doubled, to $220 a month.

She and her fiance had planned to marry on Dec. 19, her late mother’s birthday. “And then,” she said, “we realized how drastically that was going to change the cost of my premium.”

As a married couple, their combined income would exceed 400% of the federal poverty level and make Benisch ineligible for financial help. Her current plan’s monthly premium payments would triple, costing her more than $700 a month.

Benisch considered a less expensive “bronze” plan, but it wouldn’t cover vocal therapy, which she needs to treat muscle tension dysphonia, a condition that can make her voice strain or give out.

If they get married, there’s another option: Switch to her fiance’s health plan in Massachusetts. But that would mean losing all her Rhode Island doctors, who would be out-of-network.

“We have some tough decisions to make,” she said, “and none of the options are really great for us.”

Lynn Arditi reports for Ocean State Media, a National Public Radio affiliate.

Chris Petersen: GOP wants to bring back 'pre-existing conditions' as a reason to deny health care

Via OtherWords.org

For my family, “pre-existing conditions” are more than a technicality. They’re a matter of life or death, of sickness or health.

My wife and I are Iowa family farmers. I have diabetes, and Kristi has a heart murmur. Without the Affordable Care Act (ACA) and its guarantees for people with pre-existing conditions, there’d be nothing standing between us and the insurance corporations.

We know firsthand what happens when insurance corporations can discriminate based on a pre-existing condition. Years ago, I had health coverage through an outside job and was diagnosed with a nickel-sized hernia that didn’t require immediate surgery. 

When farming started looking up, I began to farm full-time and applied for my own insurance. My wife and I disclosed our health conditions and were approved. Each month we religiously paid the $700 premium.

After about a year, I decided to fix the hernia and was pre-approved for surgery. Then the bills started. After months of back-and-forth, my insurer denied the claim, citing a pre-existing condition. They dropped me.

Then my wife had pre-approved tests for her heart, and the insurer dropped her, too. They cited “discrepancies” between medical records and the insurance forms we’d filled out two years earlier.

The discrepancies? A one-inch difference in her height and the fact that she’d gained 12 pounds!

It took us 14 years to pay those medical bills with no help from the insurer. After years of us sending them monthly premium payments, they’d left us holding the bag.

Then came the ACA. Kristi and I finally got quality, affordable health care, like many other small-business owners. The law isn’t perfect, but it provided a measure of stability we needed to keep our business going strong.

Now the Trump administration and some Republicans in Congress are attacking the ACA again. They want to let insurance corporations discriminate against people with pre-existing conditions, like my wife and me.

This comes after Republicans in Congress voted to pass the new tax bill — a huge giveaway to giant corporations that did nothing for farmers like us.

This tax bill doesn’t just funnel billions in preferential tax treatment to mega-corporations. It also eliminates the ACA’s penalty for not having health insurance. Trump is using that as an excuse to ask a judge to throw out the ACA’s pre-existing condition protections, too. A new Trump-appointed Supreme Court justice like Brett Kavanaugh just might help him do it.

Meanwhile, Republicans in Congress are advancing a budget that cuts health care and raises prices for all of us enrolled in Medicare, Medicaid, and the ACA.

Let’s not go backwards.

Any politician who believes in thriving family farms and small businesses should protect people with pre-existing conditions and support universal health care.

Any politician who believes in us should reverse the Republican corporate tax giveaways and adopt fair taxes that fund public investments and help fuel small business development.

And any politician who supports us should reject the finger-pointing. No more blaming our hard times on immigrants, people of color, or on those who seem “different.” Our strength comes from working together — on health care and all the other things that matter in our lives.

Last year, the GOP Congress tried to repeal our health care. People of all walks of life stopped them. Believe me, like my friends and neighbors, this family farmer is persistent. We’re not done fighting for everyone to get the health care they need.

Chris Petersen is an independent family farmer near Clear Lake, Iowa. He’s a leader of the Main Street Alliance, a national small business network. 

2 N.E. healthcare leaders warn of effects of ACA repeal

Adapted from an entry on the Cambridge Management Group (cmg625.com) Web site:

The Republicans’ promise to repeal the Affordable Care Act not only threatens to deprive millions of people of their health insurance; it could drive many hospitals deep into debt and destroy innovative programs created by the ACA aimed at  improving patient care, two New England healthcare leaders say.

Timothy Ferris, M.D., an internist and medical director of the Mass General Physicians Organization, told FierceHealthcare that he worries that the “progress we’ve made over the past five years would be threatened.”

He said that  includes programs through the Accountable Care Organization (ACO) at Massachusetts General Hospital, including experiments with video consultations and home hospitalization.

Dennis Keefe, head of Care New England, in Rhode Island, told NPR that he is concerned about the future for Integra, an ACO that includes primary- care physicians, specialists, urgent-care and after-hour providers, clinics, laboratories and inpatient facilities.

Hospitals and healthcare systems that have spent the last six years trying to create new value-based, patient-centered models as part of the ACA.  And so 120 organizations sent a letter to President  Trump and Vice President Pence urging them to not roll back progress they have made.

To read more, please hit this link.

David Warsh: Health economist reaps whirlwind from his irony

Irony – the tendency to underscore a point by stating the opposite of what is meant – has been the downfall of many an advocate.  It’s an often powerful technique. In political speech, though, it is prone to backfire, because it can easily be taken out of context. It’s more dangerous than ever in the age of YouTube and opposition research. Accept that “oppo” has greatly damaged the effectiveness of Jonathan Gruber, of the Massachusetts Institute of Technology, the economist who in 2004 framed the financial strategy that, over a twisted course, led to the adoption of the Affordable Care Act, in 2010.   Gruber is a leading healthcare expert, much in demand.  For two weeks he’s been at the center of a firestorm because of three video clips in which he seems to give comfort to enemies of Obamacare.

The story of how investment adviser Rich Weinstein, angered because he was forced to search for a new policy under terms of the ACA (he found one),  turned amateur sleuth, searching through hundreds of online videos, radio interviews and podcasts to find three damaging ones, makes interesting reading. We owe it to reporter David Weigel, of Bloomberg Politics.

The ACA requires those who don’t receive health insurance benefits from their employer or from the government to buy their own insurance, much as licensed drivers must purchase automobile insurance, with government subsidies for health insurance for those who earn less than a certain amount.

According to Gruber, the bill was written in a “tortured” way to avoid describing its mandates as taxes.  He told a health care conference at the University of Pennsylvania last year that ''Lack of transparency is a huge political advantage, Call it the stupidity of the American voter or whatever, but basically that was really, really critical to getting the thing to pass.''

Gruber was being ironic.  Addressing an audience of healthcare professionals, he meant that, for good reasons or bad, in extending insurance to those who couldn’t afford it or even obtain it, that Americans had done the right thing.  Sleuth Weinstein found two other clips in which Gruber seemed to buttress Republican argument that insurance obtained on a federal exchange is not eligible for subsidies because the legislation anticipated that all states would form exchanges of their own. Twenty-four states, all with Republican governors, refused to form such exchanges. The  federal government formulated a marketplace in their stead.

“Health Adviser Logged White House Visits,” headlined The Wall Street Journal. “Fallout From Gruber’s Remarks Spreads: Economist’s Comments on Affordable Care Act’s Passage Prompt Vermont to Cut Ties, Michigan Lawmakers to Seek Probe.” .

In an editorial, “The Impolitic Jonathan Gruber,” The New York Times came to the ACA’s defense:

''Republicans are crowing over Mr. Gruber’s remarks because he has been portrayed as a major architect of the health reform. In truth, his role was limited.  He had a big contract with the White House to use his econometric model to calculate the financial and coverage effects of proposed measures.  And he was one of thirteen experts who advised the Senate Finance Committee.  His comments should not be taken as evidence that the reform law was hatched in secrecy and foisted on the public by trickery.''

It depends, I guess, on what is meant by “truth.” In truth, Gruber’s role in devising the mandate strategy of the ACA was absolutely fundamental. The idea had originally been proposed in  the early 1990s by the conservative Heritage Foundation as an alternative to Hillary Clinton’s much farther-reaching plans. Gruber dusted it off and broached it in 2004, at the request of then-Massachusetts Gov. Mitt Romney. Romney was in the early stages of preparing a presidential bid.  His plan was adopted by Massachusetts’ s heavily Democratic legislature, with apparent success.

The mandate idea was taken over by the Democrats in the campaign for the 2008 presidential election.  By now a leading expert on its operation, Gruber first advised John Edwards, then Hillary Clinton, and finally Barack Obama on the details of the plan. In early 2010, President Obama relied on Democratic majorities in both the House and Senate to pass the measure into law.

Was it a good idea?  Some Democrats have begun to voice their doubts. Sen. Charles Schumer (D.-N.Y.)  said, last week: “It wasn’t the change we were hired to make.” The party should have found a way to raise wages and create jobs, instead of focusing on the uninsured, he continued, whom he described as “a small percentage of the electorate.”

David Axelrod, a close adviser to President Obama in both campaigns countered (in a another story in the WSJ ), “If your calculus is solely on how to win elections, and that is your abiding principle, it leads you to Sen. Schumer’s position. But that’s precisely why big difficult problems often don’t get addressed in Washington, and why people have become cynical  about that town and its politics.”

The ACA will continue on its perilous course in the courts, this time in King vs. Burwell, a challenge to subsidies for those policies obtained from the federal exchange.  The 2016 elections come after that.

With much rule-changing still to be done before the huge medical sector becomes stable, U.S. healthcare reform is like global warming: Further measures are not a matter of if but when.

David Warsh, a longtime financial  journalist and economic historian, is proprietor of economicprincipals.com

ACA a boon for 'safety-net' hospitals

Except for states (mostly  in the South) that refused to accept Medicaid expansion under the Affordable Care Act, the ACA has been a boon for "safety-net'' hospitals that service large numbers of poor people. That's because the ACA, by enabling millions of previously uninsured people to get insurance (many of them via Medicaid programs), has dramatically reduced pressure on hospitals to provide uncompensated care.

See this comment in Cambridge Management Group's Web site.