healthcare cost

ACA changes: Higher premiums, fewer enrollment options

People heading into the Affordable Care Act open enrollment period with plans to sign up for insurance should expect a variety of changes in 2027, including higher premiums and fewer coverage options.

The sign-up window for the marketplace, also known as Obamacare, started Sunday in most states and runs through Jan. 15.

Big changes to the exchange include expiring financial assistance, rising rates, potential delays in working with a broker, new restrictions on immigrants, and stricter enrollment checks.

Financial help, including premium tax credits and cost-sharing reductions, is now restricted for many groups of people who were previously eligible.

Across the board, healthcare experts predict less coverage and higher prices, with the average price of health insurance purchased through the marketplaces expected to rise by 13% in 2027, according to analysis of new CMS data by the healthcare research nonprofit KFF.

Increases are driven by multiple factors

Cynthia Cox, a vice president and director of the ACA program at KFF, said the increase is primarily driven by rising healthcare costs, hospital market concentration, and potential factors such as the No Surprises Act, which took effect in 2022 and bans surprise billing, or the rising availability of GLP-1 drugs.

The people who will be most affected by the new increases are those who do not qualify for a subsidy.

“They may or may not be able to afford to continue to keep their coverage into next year,” Cox said, adding that “a lot of them have already moved into bronze plans, which are the cheapest plans.”

A CMS fact sheet about open enrollment that was distributed Friday says, “Americans using HealthCare.gov will have robust access to low-cost plans.”

The price of ACA insurance has skyrocketed for many people during President Trump’s second term after Republicans opposed extending COVID-era subsidies that had helped offset the costs of health insurance for most enrollees during the Biden administration.

That resulted in 1.2 million fewer people signing up for coverage in the exchanges.

Falling number of enrollees

As of February, roughly 19.2 million people in the United States were actively enrolled in ACA marketplace health plans, according to the Department of Health and Human Services website. The number of enrollees grew during the COVID-19 pandemic when enhanced subsidies became available through the American Rescue Plan Act and Inflation Reduction Act, both signed into law by President Biden.

New regulations starting in 2027 will also limit tax credits for certain lawfully present immigrants, which could result in an additional 1 million uninsured individuals over time.

Meanwhile, the Trump administration has been removing ACA enrollees from the program as part of the ongoing campaign against what it characterizes as waste, fraud and abuse.

In September, Vice President JD Vance and other officials in the Republican administration announced plans to remove 760,000 ACA enrollees from public healthcare exchanges, alleging the individuals were fraudulently enrolled in the program or simply did not exist.

Vance said the discovery and canceled subsidy payments for hundreds of thousands of people from the exchanges, part of an administration-wide crackdown on alleged fraud, would result in $2.2 billion in cost savings.

It’s unclear how many more people will drop off of ACA coverage in 2027, Cox said. But with higher premiums, immigration eligibility changes and the anti-fraud efforts, “I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why.”

Hussein writes for the Associated Press.

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She voted for Trump every time. Then came cancer and the bills

The Ford Expedition rumbled to a stop and Cindy Banda’s bedazzled flip-flops landed on the asphalt of the Houston cancer center’s vast parking lot. She threaded through the rows of cars, a tally of patients who gather here to sit with chemotherapy needles or lie on radiation machines.

The elevator dinged open. A year ago in this building, surgeons removed Banda’s right breast, and she still didn’t know whether treatment had expunged the cancer from her body. Doctors had told her it would be tough to beat.

“I’m more of a positive person myself,” Banda said, now sitting with a white wristband in a dim waiting room. But the bills are harder to dismiss, and the single mother with six children in her care repeated something like a mantra. “Keep the house. Keep the cars. And just keep the kids stable.”

That’s true for many Americans, as rising healthcare costs leave more families with a sinking feeling after seeing the bill for surgery or medication. Heading into the Nov. 3 midterm elections, about half of registered voters said healthcare costs are a major problem for them and their families, up from a little more than one-third four years ago, according to a Fox News poll from September.

With party control of Congress at stake, registered voters are nearly twice as likely to say they trust Democrats over Republicans to handle healthcare, according to an Associated Press-NORC Center for Public Affairs Research poll from the same month. Those frustrations, combined with broader concerns over rising prices, have sapped support for President Trump and his Republican Party.

Banda knows how that feels. She backed Trump in each of his three campaigns, motivated by her opposition to abortion. But when cancer came, the ensuing scramble to make ends meet was painful enough to rearrange her priorities, and she started to think about voting Democratic for the first time.

The 46-year-old was ushered into a sterile room for her appointment, her phone lighted up with a text. “Please contact TD Auto Finance.”

“This one’s $1,300,” she said of the car payment bill. “I have to go back to work.”

She had been on sick leave for a year from her job selling internet service, and she needed the income to support her three children and three more she had taken in after her sister’s death.

The doctor said her reconstruction surgery could be scheduled early next year. “I was hoping for maybe December,” Banda said, “only because I’ve met my deductibles.” Come January, she would have to pay down the $7,500 again. Earlier may be possible, the doctor replied, if the skin around her surgical scar loosens.

The evening had cooled slightly by the time she walked back through the rows of parked cars, their ebb and flow marking the tide of sickness, survival and death in a small corner of a colossal healthcare industry that saves lives while taking in over $5 trillion every year.

Banda paid $8 for parking as she left.

Confronting death and debt

Two weeks later, Banda was back at work, making door-to-door rounds to sell Spectrum’s Wi-Fi in McAllen, her city along the U.S.-Mexico border in the Rio Grande Valley. Banda, holding blue fliers, walked along a row of storefronts, some that closed since she last was in the area.

She hadn’t had a sale and commission since October of last year, after the biopsy and diagnosis.

The doctor who gave her the news had hugged Banda, and she sobbed even though, she says, she never really sobs in front of other people. During chemo, her children took turns buzzing off her wispy hair. When her 9-year-old daughter’s hand quivered, a teenage cousin helped guide the clipper over her mother’s scalp.

Banda’s first impulse was to maintain normality, stability, for the children.

But that requires roughly $7,000 a month for utilities, mortgage, car payments and groceries, along with the two water leaks. Then, even with insurance through her job, the surgeries, chemo and radiation added up to over $25,000 that she’s been paying off, making Banda one of tens of millions of other people in the United States in medical debt.

Banda tries not to dwell on death and debt.

“It’ll consume you,” she says. She smothers those thoughts beneath her bubbly demeanor and avoids being alone. But that truce, between her insistence on positivity and the fears that it covers, is brittle.

Certain thoughts still arrive uninvited. Banda’s late sister, Melissa, didn’t have life insurance. Banda makes sure it’s a payment she never misses.

“Sometimes I think, and I shouldn’t think like this, but I’m worth more gone than here,” she said one day. “Obviously, the goal is not that, the goal is to beat it,” she continued, “to keep the house and keep the cars.”

So far she has, with the help of others.

On top of child support, the father of Banda’s 9-year-old often pays $400 a week for a nanny to help with the kids. Banda’s own father sent her $700 before for her recent Houston appointment, one of his many cash infusions. Her high school classmates, whom she hadn’t been in close touch with in decades, fundraised by selling grilled chicken, rice and beans from a roadside tent. Two GoFundMe fundraisers collected nearly $30,000, and Banda rented her late sister’s house while putting her own in forbearance.

But months of insecurity takes its own, sleepless toll. She needed to sell some internet services to catch up.

After sticking the Spectrum Wi-Fi fliers onto empty storefronts, she drove to pick up her kids from school. The following day she had a morning meeting at a barbershop for what would be her first sale back at work.

Turning on Trump

A lifelong Christian, Banda had voted her antiabortion stance in past elections. When her sister was kidnapped and murdered by her ex-husband in 2020, Banda retreated from religion. The cancer brought her back to church with an apology to God, but it also made her rethink her politics.

She voted for Trump in 2016, and his first four years seemed steady, she said, so she voted for him again in 2020. President Biden’s tenure, including a global pandemic and related inflation, felt like bedlam, so she voted for Trump to return to the White House in 2024.

But two years later and fighting an expensive disease, she had found no respite from high prices.

So when James Talarico, a Presbyterian seminary student running for U.S. Senate as a Democrat, visited one of Banda’s fundraisers — speaking about his diabetes and his work in the Texas Statehouse to lower the price of insulin — it moved her. “Imagine if he can do that for the cancer,” she said.

Talarico and his Republican opponent, state Atty. Gen. Ken Paxton, have different approaches to healthcare. Talarico wants all Americans to be able to join Medicare; Paxton proposed a $25,000 tax deduction for out-of-pocket medical expenses.

Talarico also supports a law guaranteeing abortion access nationwide, which Banda has voted against for years. But after she slid into debt to stay alive, after her grocery bills mounted and the high school had to comp the kids’ soccer gear she couldn’t afford, Banda’s antiabortion concerns have been superseded by worry about costs.

“Because it’s what I’m living,” she said. “I’m living it.”

Banda cast an early ballot for Talarico. “Never voted Democrat before today!!” she wrote in a text with blue heart emoji.

Awaiting news

Banda had just started a new cancer-targeting medication that cost $16,000 a month, reduced to $500 by insurance. By the afternoon, she was nauseated and fatigued, unable to eat. The malaise would keep her home the next day. She would miss the meeting with the barbershop to close her first deal since getting sick, though she felt confident it was in the bag.

But Banda pushed through the discomfort one evening to join her family as they replaced the flowers at her sister’s tomb.

She drove past the headstones and oak trees in the evening’s slanting light, and the family gathered around Melissa Banda’s tomb in an open-air mausoleum. There was no speech. Their eulogy was her father, Fidel Banda, methodically clipping and arranging the flowers for his daughter.

Banda walked along the wall of tombs. She will find out on election day whether the cancer is in remission or whether it’s spread to her organs.

“This one’s for me,” she said, pointing to a blank tomb next to her sister’s.

“Mom!” said her daughter with the huffiness of a 9-year-old. “Why would you say that?”

Banda smiled and added, “in a hundred years.”

Bedayn writes for the Associated Press.

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