A MARTÍNEZ, HOST:
A government shutdown is looking more and more likely. And this time, it could be far more severe than in the past.
STEVE INSKEEP, HOST:
A memo from the White House instructs federal agencies to prepare mass firing plans if funding lapses at the end of the month. This plan goes beyond the usual temporary furloughs during a shutdown. It would permanently cut jobs in programs that are established by law but the president doesn't like. As so often happens, Republicans and Democrats do not agree on a funding measure for the fiscal year that is about to start. Republicans want a short-term extension, while Democrats have insisted that extension should include some protections for people who have health insurance premiums to pay.
MARTÍNEZ: NPR's Selena Simmons-Duffin covers all things health insurance. All right, so let's start with deadlines here. The shutdown could start next week, but there are other key dates at play.
SELENA SIMMONS-DUFFIN, BYLINE: Yeah. So in just over a month, on November 1st, open enrollment begins on the Affordable Care Act marketplaces. You might know them as Obamacare, healthcare.gov. That's all the same thing. And this is where people shop for insurance if they don't get it through their job - so, you know, a lot of freelancers, small business employees. At the end of the year, something called the enhanced premium tax credits expire. Those have kept premiums affordable for people who get their insurance this way. And if Congress doesn't act to extend those tax credits in the next week or two, people are going to get sticker shock when open enrollment starts and they see that monthly amount they pay for health insurance is going to go way up next year.
MARTÍNEZ: Where did these tax credits come from?
SIMMONS-DUFFIN: So when the ACA was passed way back in 2010, Congress created kind of a sliding scale to help give people a break on their premiums. But the way it was originally set up didn't work very well. Premiums were still really high for a lot of people, so enrollment was sluggish. And in 2021, Congress stepped in. They sweetened the pot with a lot more federal funding, which made premiums more affordable for people at all income levels. Sabrina Corlette of the Georgetown Center on Health Insurance Reform told me that worked. Enrollment more than doubled. It's now 24 million people. And the uninsured rate for the entire country sank to the lowest it's ever been.
SABRINA CORLETTE: Incredibly successful effort to get more people into coverage and reduce the uninsured rate.
MARTÍNEZ: All right. So what happens, though, if the enhanced credits expire?
SIMMONS-DUFFIN: In short, people's costs will go up and enrollment will drop. Ultimately, millions of people could become uninsured. Yesterday, I talked with Emily Pisacreta. She's a senior producer with the health care podcast An Arm And A Leg, which partners with KFF Health News and NPR member station KUOW. They just did an episode about her quest to find ACA insurance, something she really needs since she has Type 1 diabetes. She found a plan that works for her for $500 per month, but it could get much more expensive next year if those enhanced credits expire.
EMILY PISACRETA, BYLINE: Five hundred dollars a month is not little. And to imagine it going up to almost $900 a month seems really scary.
SIMMONS-DUFFIN: I talked to somebody who lives in West Virginia who's putting money aside that would go to retirement because of these changes. And another person in Florida told me he's considering finding a new job with benefits if his premium becomes unaffordable.
MARTÍNEZ: So what are the politics on all this? Where does that stand right now?
SIMMONS-DUFFIN: There are Republican lawmakers who would like to extend these tax credits, others who really don't want to. But either way, it's really hard to see this getting resolved before a shutdown next week since there are no - currently no active talks between the two parties.
MARTÍNEZ: That's NPR health policy correspondent, Selena Simmons-Duffin. Thanks a lot.
SIMMONS-DUFFIN: You're welcome. Transcript provided by NPR, Copyright NPR.
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