Affordable Care Act subsidies debate could impact North Carolina healthcare costs

CHARLOTTE, N.C. (WBTV) – The recent government shutdown highlighted a continuing battle over healthcare, specifically the extension of enhanced Affordable Care Act (ACA) subsidies.

The outcome of this debate in Washington could significantly impact how much North Carolinians pay for their health insurance.

For 67-year-old Gerry Fiesler and his 62-year-old wife, Kelly, healthcare is essential. Gerry Fiesler is on Medicare, but Kelly Fiesler, who has an autoimmune disease and Crohn’s disease, relies on the ACA Marketplace.

Thanks to expanded federal subsidies, they currently pay just $60 a month for Kelly Fiesler’s coverage. However, if these subsidies expire, their bill could jump to over $450 – a 750% increase.

“It’s a good program. It really is. The insurance is good. It was affordable,” Kelly Fiesler said. “I think because of the income I reported was a little more they put us in a tier. I think the deductibles are higher a lot of changes. I haven’t even approved the plan yet for 100%.”

Facing rising costs for food, gas, and other necessities, the Fieseler’s have made the difficult decision to sell their retirement home of eight years.

“We have to do that, it’s the only way we may survive this. It’s about survival. I don’t know how long it’s going to last with us with the money and all. I may have to go back to work,” Gerry Fiesler said.

The number of North Carolinians insured through the ACA Marketplace has doubled since before the pandemic, from 500,000 to nearly 1 million, largely due to the affordability subsidies provided.

Nicholas Riggs, Director of the NC Navigator Consortium, warns of the consequences if subsidies are not extended.

“Without the enhanced subsidies, people are seeing their premiums jump two to three times what they are right now,” Riggs said “And not only that, but for individuals who are above 400% of the federal poverty level, they will have to pay full price for marketplace plans if the enhanced subsidies aren’t extended.”

Who currently qualifies for enhanced subsidies?

• Individuals making up to $62,000
• Couples making up to $84,000
• Families of four making up to $128,000

If subsidies expire, the previous rules will return, potentially eliminating eligibility for many middle-income households, including those who are too young for Medicare and do not qualify for Medicaid, yet cannot afford to go without medical care.

“The American dream is slowly getting out of reach for most people, I think,” Gerry Fieseler said.

Riggs advised against panic, stating that even if enhanced subsidies expire, other subsidies and marketplace plans will still be available.

“There are four different categories of plans. There’s bronze, which covers 60% of out-of-pocket costs, silver, which roughly covers 70% of out-of-pocket costs, gold, 80%, and platinum, 90%. So we always want to make sure that folks do know that there are health coverage options available in the marketplace, regardless of what’s going to happen with the subsidies,” Riggs said. “And it is much better to protect yourself against a health emergency and have coverage, even if it’s a bronze plan, than to go without coverage at all. So explore your options.”

The decision by Congress will determine whether hundreds of thousands in North Carolina maintain their health coverage. Navigators recommend checking options early and not panicking.

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