Pay twice as much for health insurance? That’s the prospect some Washington residents face

A clash over health care tax credits is at the center of the ongoing federal shutdown. Democrats want those subsidies extended. But many Republicans want to let them expire. That leaves thousands of Washington residents who rely on the subsidies to pay for health insurance with tough choices: pay the new rate, purchase catastrophic coverage, or forgo health insurance altogether.

For most of her career Maya Tussing has worked at large investment firms that usually offered generous health plans.

“It’s like being in a candy store,” said Tussing. “You get to pick almost every type of plan, if you want a PPO, or HMO, and any type of deductible you want.”

In 2019 Tussing and her business partner started Fairlight Advisors to help nonprofits manage their endowments. It was the first time she shopped for health insurance.

“It’s a huge undertaking,” Tussing recalled. “It’s the last thing you think about.”

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Tussing found coverage through the Affordable Care Act. She and her family were living in California at the time. Because she had no income yet, she didn’t pay anything. But as the business grew, she started paying premiums.

When Tussing moved to Washington, she was paying $200 a month, thanks to the federal subsidies. The tax credits are calculated based on factors such as household income and family size. This year, her premiums are still subsidized, but they’ve gone up to $1,100 a month for a plan that covers herself, her husband, and their daughter.

“The insurance plan I have now, I know where the clinic is, I know the doctors I have, and how much I would pay,” Tussing said.

The Enhanced Premium Tax Credits, as they’re called, have helped more than 216,000 Washington residents. About 25% of the state’s marketplace customers are self -employed or small business owners like Tussing. The subsidies were introduced in 2021 during the Biden administration to help with post pandemic recovery. Those subsidies will end this year. Many Republicans say they should be left to expire to help curb government spending.

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Without the tax credits, Tussing expects her premiums to cost more than $2,200 a month. She’s checked in with insurance brokers to find the best and lowest cost option for her family, but the options are limited.

“At the moment total insurance is taking up 50% of our income — that’s auto, health, life, and home insurance," she said.

Tussing has to make a decision soon. Open enrollment for health insurance starts next month, when Americans start shopping for insurance plans.

For Tussing, going without coverage is not an option. But she wants to see a long-term solution so people can afford coverage.

“Do you want people to take on more debt? Already we have people who don’t have enough in retirement," she said. "Do you want people to start tapping their IRAs so they can pay for health care?”

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Once the tax credits expire, the state estimates 80,000 people will forgo coverage. Coupled with Medicaid cuts, officials say it will take the state back to the days before ACA, when the uninsured rate was 15%. Currently it’s less than 5%. They worry it will further drive up the cost of premiums and cause people to wait until they’re sicker to seek medical care, leading to higher uncompensated hospital costs, bad debt, and bankruptcy.