At the Prosper Health Coverage Center off I-35 in South Austin, volunteers and specialists are busy manning the phones and meeting in-person with Texans throughout the month of November. Clients who walk through the nondescript office\u2019s doors seek free assistance enrolling in health insurance through the Affordable Care Act marketplace.<\/p>\n
Around 4 million Texans are currently enrolled in marketplace plans, often because they are self-employed or work for a small employer that does not offer insurance. This year, many of these customers \u2014 like Britta Lee, who asked to be referred to by her first and middle name due to privacy concerns \u2014 are being confronted with higher premiums.<\/p>\n
\u201cWe had to scramble to find a plan that even gives me close to the amount of coverage I had before, which means half of my doctors I have now I won’t be able to go to next year,\u201d Lee said after her Prosper Health appointment.<\/p>\n
After Lee learned her 2025 plan wouldn\u2019t be affordable for next year, she searched the marketplace for a plan she could afford. She was able to find one, partly due to premium assistance she receives as a resident of affordable housing operated by Foundation Communities, the organization that oversees Prosper Health Coverage.<\/p>\n
But her monthly payment will still be higher. She said that will mean trimming an already tight household budget \u2014 from eating less meat to forgoing the occasional night at the movies.<\/p>\n
\u201cAnything fun that we want to do, it has to be free, and we cannot travel at all,\u201d she said.<\/p>\n
Expiring federal subsidies<\/p>\n
Lee isn\u2019t alone. In states like Texas that use healthcare.gov, insurers are charging around 30% more next year, according to an analysis<\/a> from the nonpartisan health policy organization KFF.<\/p>\n Most Americans have their ACA insurance costs offset to some extent by federal subsidies called premium tax credits, depending on their household income. Back in 2021, the Biden administration enhanced those tax credits, giving poorer households more support and giving some middle income earners a subsidy for the first time.<\/p>\n But that pandemic-era enhancement is set to expire in January. That means higher costs \u2014 more than double for many folks, according to KFF.<\/p>\n Erika Leos, the director of Prosper Programs at Foundation Communities, has fielded a lot of questions from clients about these changes.<\/p>\n \u201cPeople were worried and just had questions, [like] ‘how does this affect my plan and my situation?’\u201d she said.<\/p>\n The answer is that it depends on the client. Factors like age and household income affect how much each person pays. Many of them will still get a tax credit of some amount, with the exception of households that earn more than 400% of the federal poverty level. Still, Leos said clients are seeing increased costs across the board; she puts it at around $100 more per month for the average Central Texas client.<\/p>\n Higher premiums or higher deductibles?<\/p>\n Ashley Velasquez, a self-employed nonprofit consultant in Austin, has purchased marketplace insurance for her family of five since 2020. She would have to pay around $1,000 more a month to keep the same Blue Cross and Blue Shield insurance plan next year \u2014 a total of more than $1,700 per month.<\/p>\n \u201cI don’t see how we could do that,\u201d she said. \u201cIt is more than our mortgage.\u201d<\/p>\n When searching the marketplace for a less expensive plan, Velasquez found that some lower-cost plans wouldn\u2019t be accepted by her primary care provider or her kids\u2019 pediatrician. After recently experiencing a nine-month wait to establish care with a new OB-GYN, she said she is reluctant to give up seeing trusted providers.<\/p>\n There are other tradeoffs, too. One plan Velasquez is considering has a monthly premium under $100 per month, but it comes with an out-of-pocket maximum of $20,000 for the family.<\/p>\n \u201cWhen you start looking at the total cost, it’s really hard to compare apples to apples,\u201d she said.<\/p>\n That\u2019s why Velasquez is also considering a plan that would cost just shy of $1,000 per month. It\u2019s about $200 more than she\u2019s used to, but she would get similar benefits to what she currently has \u2014 and peace of mind should one of her three kids get sick or hurt.<\/p>\n \u201cIf somebody falls off the monkey bars and breaks an arm, we need to be able to take them to the emergency room and know that they’re going to get care that’s going to be covered by a health insurer,\u201d she said.<\/p>\n Ongoing federal uncertainty<\/p>\n There is still a chance Congress could vote to extend the enhanced premium credits in December. Getting that vote on the Senate docket was part of the deal Democrats made<\/a> to end the federal government shutdown earlier this month. But many Republicans are still resistant, citing the estimated $350 billion<\/a> the enhanced tax credits would add to the national deficit over the next decade.<\/p>\n Heading into enrollment season, Leos was concerned that all this uncertainty at the federal level would result in a lot of folks forgoing health insurance altogether. Researchers at Texas A&M<\/a> have estimated hundreds of thousands of Texans might do so.<\/p>\n \u201cThat was one of the things we were kind of worried about, that people might choose either not to enroll at all or \u2026 decide before even checking for prices and plans,\u201d she said.<\/p>\n Leos said so far, most of her clients at Prosper Health are choosing a plan \u2014 even if their budget takes a hit. As of Monday, she said the organization had helped to enroll around 1,370. The staff, which is supplemented by more volunteers this year due to federal funding cuts, hopes to enroll at least 5,000.<\/p>\n Texans have until Jan. 15 to enroll but must enroll by Dec. 15 to have benefits kick in at the start of the year.<\/p>\n