A MARTÍNEZ, HOST:
The government shutdown has ended without resolving a fight over health insurance. Democrats wanted to extend tax credits that have helped many Americans pay their costs since 2021. Many Republicans, though, oppose that, but say they'll consider it now that the shutdown is over. So what happens now?
STEVE INSKEEP, HOST:
NPR's Selena Simmons-Duffin reports on health policy and joins us now. Hey there, Selena.
SELENA SIMMONS-DUFFIN, BYLINE: Hi. Morning, Steve.
INSKEEP: How do these tax credits work?
SIMMONS-DUFFIN: Well, essentially, it's extra financial help from the federal government that brings down the cost of health insurance premiums in the Affordable Care Act marketplaces. So Democrats want to maintain pretty generous subsidies that have, for the last few years, kept premium costs down for about 22 million people. Many Republicans say the subsidies don't address the problem of rising health care costs and that they were supposed to be a temporary pandemic policy whose time has come, and say they're open to extending them for a year. Democratic senators secured a promise for a vote on this issue, at least in the Senate, before the end of the year. But open enrollment is happening now, which leaves enrollees in a really tricky situation.
INSKEEP: Now, you've done something really, really helpful here because people argue about these issues in the abstract or talk in general terms about who they imagine is receiving the subsidies, but you've been talking to some of the actual people. What are you hearing?
SIMMONS-DUFFIN: Oh, it is rough. I mean, yesterday, I spoke with Amy Jackson. She lives in Butler, Missouri. She's 56. She responded to NPR's call asking to hear from people navigating this right now. She buys coverage on healthcare.gov because her employer is too small to have health benefits. She actually works in medical billing at an independent urgent care center.
INSKEEP: Wow.
SIMMONS-DUFFIN: She told me her insurance premiums are affordable for her at the moment.
AMY JACKSON: Right now it's closer to $300. However, if you don't count the tax credit, it goes to $1,250.
SIMMONS-DUFFIN: And do you have an extra $1,000 a month?
JACKSON: No. No, I really don't. No.
SIMMONS-DUFFIN: Going without insurance is really not an option for her. In October, she was diagnosed with breast cancer. She's rushing to get in as much treatment as she can before the year ends, but she'll still need coverage for follow-up appointments next year. She says she works in the medical field. She knows the insurance industry is part of the problem here. But she says people like her need help now, and congressional lawmakers need to understand that.
JACKSON: You know, for them, a thousand bucks is probably nothing. It's probably what they blow on dinner. But for me, that's half of my wage. You know, I just can't swing that.
SIMMONS-DUFFIN: She's been reaching out to her representatives. She says lawmakers could just flip a switch and fix this.
INSKEEP: Is that right? Is it that simple?
SIMMONS-DUFFIN: I mean, if there were political will and bipartisan agreement, yes. Congress could extend the subsidies pretty easily. It's not cheap. The Congressional Budget Office estimates it would cost about $350 billion over 10 years to keep subsidizing people's premiums so much. Republicans control both Houses of Congress and the White House. So even if senators come up with a bipartisan bill, it would need to get through the House, and President Trump would need to sign it. So what really happens here depends on Republican leadership. And right now there's only been some signals that an extension might be possible, but no concrete deal has come through yet.
INSKEEP: What should people do who are supposed to sign up now?
SIMMONS-DUFFIN: Well, they can definitely go in and shop and get an idea, but they should probably keep one eye on the news. That's what Amy Jackson told me she's doing. And there's about a month to go before people have to pick a plan that begins January 1.
INSKEEP: NPR's Selena Simmons-Duffin. Thanks, as always.
SIMMONS-DUFFIN: You're welcome. Transcript provided by NPR, Copyright NPR.
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