One in three Americans forced to make financial sacrifices for health coverage

[0:00] at a moment when there's a lot of political attention around affordability [0:04] rising health care costs are a growing concern for many americans that's especially true for [0:09] anyone worried about affording insurance premiums after an expansion of subsidies for the affordable [0:14] care act expired but they're not the only ones struggling with this stephanie sai tells us more [0:21] a recent report from the west health gallup center revealed that one-third of americans [0:26] are making tough trade-offs to afford health care skipping meals driving less and borrowing more [0:32] the survey involved 20 000 adults many of those facing financial burdens don't have insurance and [0:38] with the end of expanded subsidies for the affordable care act for a lot of people last year that number [0:44] is growing we spoke to some americans who have had obamacare about what they're dealing with now as [0:50] they face higher premiums and less assistance brian lantier and i live in new york city my [0:56] name is micheline pierrett berry i live in santa monica california i believe my premium expired or [1:03] my plan expired in december um december 15th or something like that but that was the date by which [1:08] i had to renew and i didn't renew for 2026. my previous plan was a silver and we're talking 236 [1:22] a month and the same plan this year is 360 for one person it went from uh 390 which is what i was [1:32] paying after the uh tax credit uh per month to i think it was 770 was the number a month i was quoted [1:40] so obviously i'd sleep better at night if i had insurance um but i understand that i'm lucky too i'm [1:46] a 54 year old man i don't smoke i have a normal bmi i have no existing chronic health issues um so i [1:56] can make this decision and i recognize that most people are not in that position i'm a cancer survivor [2:01] so the aca allowed me to have the best care when i was diagnosed and the best follow-up care i don't [2:12] really have to participate in it because i'm relatively healthy and i don't have any chronic [2:15] health issues i take no prescriptions but i also watch my mother go through her at the end of her [2:21] life and have five hospital visits that were over three months of the end of her life um in in a [2:29] incredibly expensive health care system the health care unfortunately that is available for people if [2:34] they do not have insurance is not it is substandard so yes whether i had to borrow the money uh i would [2:43] remain on my plan uh because my life depends on it if something were to happen that would be my plan is [2:50] to tack you know go out and pay out of pocket i'm basically self-insuring right now is the plan it is [2:57] my hope that with enough pressure and legislation the subsidizing of health care can uh be something [3:06] less of a political issue and more of just a basic human care that is tended to by our our administration [3:16] current and subsequent administrations a number of polls show it's not just people who use publicly [3:23] subsidized health care who are struggling with rising health care costs but also people on employer [3:29] subsidized health plans and this all comes at a moment when the president and a republican-led congress [3:35] have implemented a number of cuts to programs the president has had some success with trying to [3:40] reduce the cost of prescription drugs but it's far more limited than advertised to help us understand [3:46] what all this means i'm joined by larry levitt executive vice president for health policy at kff [3:53] larry thank you for being with us it's now been several months since it was projected that at least [3:58] two million americans would lose those expanded aca subsidies and the wall street journal reported [4:05] that in january 14 percent of aca enrollees did not make their payment what do we know about those [4:12] people and how this is actually impacting patient health yeah i mean we're forcing people into very [4:19] tough choices uh as those uh two folks you you interviewed made clear uh you know once these expanded [4:27] premium subsidies expired at the end of the year uh about a million fewer people signed up for [4:33] coverage uh but then as you said the wall street journal is reporting this new study that shows [4:38] that even the people who signed up uh once they got the those bills in the mail and had to pay their [4:43] premiums in january many of them them didn't uh and we found similar things in in our own polls where [4:50] where people say their costs have gone way up these are these aca or obamacare uh enrollees and they [4:57] are being forced to cut back on on other household spending uh or in many cases go without insurance [5:03] entirely right now the republican controlled congress isn't doing anything to restore those [5:08] subsidies what does that mean going forward for those people yeah i mean i think we're looking at [5:13] certainly a year of people uh continuing to face these uh very very high out-of-pocket premiums with the [5:20] subsidies expired i mean in theory congress could come back and extend them and make the expanded [5:26] subsidies retroactive to the beginning of the year uh but uh yeah as we're seeing congress is having [5:31] trouble doing much of anything and there are still big disagreements between democrats and republicans [5:37] over whether to extend these subsidies how does that intersect with the aca extended subsidy or [5:44] expanded subsidies ending yeah i mean these are all kind of mostly low and middle income people [5:50] who are getting these aca subsidies or relying on medicaid for their health coverage and in the the [5:55] so-called one big beautiful bill that republicans passed last year they cut medicaid by almost a [6:01] trillion dollars over a decade and that's the the biggest rollback in federal support for health care [6:07] ever these cuts are mostly uh backloaded many of them won't take effect for years but starting january [6:14] 1st new work requirements uh for medicaid enrollees uh will take effect and the expectation is millions of [6:21] people will end up without insurance as as a result of that they're either uh going to have their [6:27] medicaid dropped because they're not working or don't qualify for an exemption or in many cases just [6:32] fall through the cracks not you know not being able to navigate the bureaucratic red tape to to prove [6:37] that they are working you have rising costs across the insurance coverage ladder whether you're on [6:44] medicaid whether you have an aca plan or whether you get it through your employer i know you mentioned that [6:50] you all at kff have done some research on that is this a critical tipping point in which we're [6:57] going to see millions of americans become uninsured and just not have access you know it's it's hard to [7:03] say when when we're at a tipping point i mean you could go back to president obama talking about health [7:09] care costs being unsustainable president clinton saying the same thing even going back to president [7:14] nixon in the 1970s saying uh health care was unsustainable and at that point it was uh you [7:19] know half a share of the economy that that it is now uh but it does feel like like these health care [7:25] affordability concerns and affordability concerns generally uh really are troubling people i mean we [7:31] ask people of your economic worries uh what are you most worried about and health care was at the top of [7:38] the list uh as you said you know while while the political debate is focused on medicaid and and [7:44] obamacare there are 160 million people who get insurance through their employer and their costs are [7:50] going up too i mean they're having more money taken out of their paycheck every month for their health [7:55] insurance premiums deductibles now are almost 1900 per person on average for people with employer-based [8:03] insurance and it's not just drug prices larry it's the cost of hospital care and you have people [8:09] and politicians blaming insurers but also drug companies and hospital systems blaming each other [8:16] how do we even begin to start to get to a solution here yeah i mean there is plenty of blame to to go [8:22] around uh drug prices are high you know the drug prices in the u.s are much higher than than in other [8:28] countries but drugs are a pretty small share of health spending if you look at what's driving [8:33] the increase in health spending recently it's mainly hospital care and in particular hospital [8:39] prices a 40 percent of the increase in health care costs in recent years has been due to hospital [8:45] spending but insurers are not immune from blame either uh you know insurers take 15 to 20 cents out [8:53] of every premium dollar for overhead and profits and i think there's going to be greater scrutiny of [8:58] that i mean what we do know is we we spend much more on health care uh than the rest of the world [9:05] we spend almost double what other high-income countries spend spend on health care and we get [9:11] less for it we have uh lower life expectancies poorer health outcomes and uh we don't even cover [9:17] everyone unlike those other countries so uh you know we are we are a bit of an island when it comes to [9:24] to health care affordability when you when you look at the rest of the world one thing that does [9:28] separate those other countries is they rely much less on for-profit insurance uh and they regulate [9:34] much more strictly uh prices of drugs and hospital care that is larry lovett with kff thank you so [9:42] much for joining us with your insights larry no thanks for having me support journalism you trust support [10:00] pbs news donate now or even better start a monthly contribution today