Mary Elizabeth Marr has had dozens of patients realize their health insurance has become too unaffordable, forcing them to change to lower quality plans or drop their coverage altogether. <\/p>\n
As the CEO of Thrive Alabama, a federally funded, community-based clinic, she provides care to underserved populations regardless of insurance status.<\/p>\n
One patient\u2019s monthly insurance costs went from $200 to $400, while another\u2019s went from $84 to $285.<\/p>\n
One patient is contemplating leaving the country for a place where health insurance is more affordable, Marr told AL.com. Many, though, have decided to go uninsured because of the high prices. <\/p>\n
\u201cWe survive on a very slim margin,\u201d Marr said. \u201cSo when people start dropping off their insurance we are not going to be sustainable and we will not be here for our patients.\u201d <\/p>\n
Since 2021, many of the people who come to Thrive have qualified for extra federal money that comes in the form of expanded federal health care subsidies. Those subsidies were meant to lower the cost of insurance found on the marketplace created by the Affordable Care Act, often referred to as Obamacare. <\/p>\n
But last week, the U.S. Senate rejected a plan to extend the subsidies. That leaves Alabamians who rely on the marketplace to figure out how to pay for skyrocketing insurance bills.<\/p>\n
Premiums for individuals enrolled in the ACA marketplace could rise by an average of 93% in Alabama, according to KFF, a health policy research nonprofit<\/a>. The nonprofit estimates about 130,000 people in Alabama are expected to lose their coverage if the subsidies aren\u2019t renewed. <\/p>\n \u201cThat estimate is a combination of people who will no longer qualify for subsidies and people who will choose not to enroll in the marketplace because now it\u2019s way too expensive,\u201d said Debbie Smith, campaign director for Cover Alabama, a Medicaid-expansion advocacy group run by Alabama Arise. <\/p>\n Marr said one of her patients opted to drop down to a Bronze plan from a Silver plan after the plan changed from $23 dollars a month to $160. But the silver plan had a $0 deductible, while the new plan has an $8,500 deductible. <\/p>\n Marr doesn\u2019t think the changes to the tax subsidies will force the clinic to close because they can rely on funding reserves for now. Instead they will likely have to provide fewer services as patients have less ability to pay. <\/p>\n But she\u2019s not ready to make those plans yet. <\/p>\n \u201cI don\u2019t even want to think about it,\u201d she said. \u201cIt\u2019s too devastating and the work we do here is too important.\u201d<\/p>\n \u2018Huge impact on the church\u2019 <\/p>\n Along with health care institutions, churches and faith centers could also be hit hard by tax subsidies expiring. <\/p>\n Rev. Shane Isner, a pastor at First Christian Church in Montgomery, gets his health insurance from the marketplace, as do many other faith leaders. <\/p>\n Baptist News reported<\/a> that small congregations would be most impacted by the subsidies expiring as they typically can\u2019t afford group plans and instead provide salary stipends for staff to use for marketplace insurance. <\/p>\n \u201cAll denominations are facing similar challenges related to health insurance,\u201d Rob Fox, president of the Church Benefits Board of the Cooperative Baptist Fellowship, told Baptist News<\/a>. \u201cBeyond the potential loss of ACA subsidies, some denominational small-employer health plans are experiencing premium increases of 30% or more.\u201d <\/p>\n Isner is uncertain what his costs will look like next year. It depends on how much of his housing allowance he uses and whether his wife gets a full-time job. In certain scenarios, he said, his premiums could double. Or they could go down. But he\u2019d likely have to pay some credits back at the end of the year come tax time, he said. <\/p>\n But that\u2019s not the case for much of his denomination. He says some pastors are seeing their premiums go up tenfold. His denomination is trying to help by providing a $2,500 grant for pastors who use ACA, but that won\u2019t cover all of the costs for everyone. <\/p>\n \u201cA lot of pastors like me rely on the ACA and I think this will have a huge impact on the church,\u201d Isner told AL.com. \u201cYou\u2019ll have less mission activity because churches need to save money, you\u2019ll have more pastors moving around because many will probably go in search of a place that allows them to afford health care, and there will be a lot of instability, I can even see churches closing because of this.\u201d <\/p>\n People in the health care industry are expected to be affected, too. About 9,100 jobs in health care could be cut if the subsidies are allowed to expire, according to Commonwealth Fund, a private foundation that supports health care research.<\/p>\n That\u2019s the seventh highest amount of any state in the country, according to the foundation. <\/p>\n Commonwealth said their \u201cconservative\u201d estimate for the economic impact<\/a> of allowing the credits to expire could amount to $63 million in state and local taxes and $968 million in GDP in Alabama. <\/p>\n \u201cThese credits expiring will have a massive impact on our state, from the economy to our health care system as a whole,\u201d said Smith with Cover Alabama. \u201cIt impacts more than just individuals.\u201d <\/p>\n Hospitals <\/p>\n The Alabama Hospital Association said that if the subsidies expire, \u201cincredible financial stress\u201d would be added to hospitals that are already operating on \u201crazor-thin or negative margins.\u201d <\/p>\n Alabama has already seen 15 hospitals close since 2011, including seven rural hospitals. Of the state\u2019s 50 rural hospitals, 27 are at risk of closure with 19 of those at immediate risk, according to the hospital association.<\/p>\n Nationwide, a new study from the Urban Institute and Robert Wood Johnson Foundation found <\/a>that that if Congress allows the enhanced premium tax credits to expire, hospitals, physicians, and other providers will face more than $32 billion in lost revenue in 2026.<\/p>\n Hospitals in particular could see $2.2 billion in unpaid bills, according to the report.<\/p>\n \u201cIf those subsidies expire in December\u2026a lot of people will lose coverage. If you have that many people who become uninsured\u2026it absolutely puts a strain on all hospitals, and it does not help our health outcomes, which are already bad,\u201d said Danne Howard, director of the Alabama Hospital Association. <\/p>\n The state has some of the highest infant and maternal mortality rates in the country<\/a>. Alabama has about 1,500 patients for every doctor<\/a>, while a third of counties don\u2019t have pediatricians <\/a>or maternity care<\/a>, and more than half of the state\u2019s hospitals are at risk of closure<\/a>. <\/p>\n \u201cThe long-term impact will be negative for hospitals, doctors, Alabama\u2019s economy, and workforce,\u201d she added. <\/p>\n National politics <\/p>\n Last week, U.S. Sens. Katie Britt and Tommy Tuberville of Alabama were among those who voted down a plan to extend the subsidies for three more years.<\/p>\n Britt said in a statement on X<\/a> that the Democrats\u2019 plan to extend subsidies, \u201cprops up a broken, UNAFFORDABLE system that\u2019s wrought with fraud and failing the Alabamians who truly need it, all while extending COVID-era subsidies with no income caps.\u201d<\/p>\n Both senators did, however, vote in favor of a bill that would put up to $1,500 into a health savings account for people who buy their insurance on the marketplace depending on a person\u2019s age and income. But that proposal also failed to pass. <\/p>\n The same day, President Donald Trump said he would work with Democrats to find a solution on health care<\/a>, but did not specify what plan he supported.<\/p>\n \u201cI think we\u2019re going to start working together on health care,\u201d Trump he said. \u201cI really predict that.\u201d<\/p>\n The enhanced tax credits were first passed by the American Rescue Plan in 2021 – they made more people with higher incomes eligible and expanded the credits to cover more costs – and were extended through 2025 in the Inflation Reduction Act.<\/p>\n In 2020, 160,429 Alabamians were signed up for subsidized health insurance through the Affordable Care Act. By 2025, that number reached 477,838 people, according to KFF<\/a>.<\/p>\n That\u2019s nearly 10% of the state\u2019s population.<\/p>\n \u201cThere\u2019s no doubt our healthcare system is broken and affordability absolutely needs to be addressed,\u201d said Smith. \u201cBut for the people who are about to lose their health coverage, there is a solution that\u2019s right there. Congress can act now to help these individuals.\u201d <\/p>\n Hard choices in Alabama<\/p>\n Adrienne Gilspie is retired from UAB Hospital and gets her insurance through UAB\u2019s plan and Medicare. But to cover her kids, she turned to the marketplace. Two of her three children are enrolled at the University of Alabama. Her eldest, who recently graduated, has a rare condition that has put him into heart failure. <\/p>\n \u201cFor years the ACA has been a lifesaver for me because my kids could get full coverage that I could afford,\u201d Gilspie told AL.com<\/a>.<\/p>\n AL.com<\/a> reviewed Gilspie\u2019s bills from last year and projected costs for next year from her insurance provider, Blue Cross Blue Shield of Alabama. <\/p>\n According to the Alabama Department of Insurance<\/a>, Blue Cross Blue Shield reported a 19.3% premium increase for people on the ACA marketplace, UnitedHealthcare Insurance Company reported a 20% increase and Celtic Insurance Company reported a 25% increase.<\/p>\n \u201cBlue Cross and Blue Shield of Alabama understands that rising premiums are difficult for our members\u2026when we set rates, we\u2019re also carefully estimating next year\u2019s healthcare costs. Uncertainty around federal tax credits and marketplace policies makes this even harder,\u201d Sophie Martin, a spokesperson for the insurance company said in a statement to AL.com<\/a> in October.<\/p>\n Martin added that Blue Cross, which is the largest insurance provider in the state, \u201cremains a strong advocate for the continuation of enhanced ACA premium tax credits.\u201d<\/p>\n As a military veteran, Gilspie can cover her youngest child on the VA\u2019s student plan. But her sons, who are 23 and 25 years old, have aged out of eligibility for that program. <\/p>\n