>> Millions of Americans could soon face higher health insurance costs.

As enhanced affordable care Act, subsidies are set to expire at the end of the year.

Those subsidies introduced in 2022.

Helped more than double enrollment in ACA marketplace plans.

Now a report from the nonpartisan Urban Institute warns that around 5 million people could lose their coverage if subsidies aren't extended.

Joining us with more are news getting up?

I professor of economics at Loyola University, Chicago and via zoom, Windy Epstein, professor of law at DePaul University.

And and Gillespie director of the Illinois Department of Insurance.

Thanks to all 3 of you for joining us.

Windy of scene starting with you.

Please clarify for us.

Which subsidies are set to expire in what will happen to premiums if they do.

>> When the Care Act was passed back in 2010 and includes subsidies that were written into the law that would help people buy policies on the exchange.

So these are folks are not eligible for Medicaid and did not have access to affordable employer-sponsored insurance.

Those subsidies are, as I said written into the law and are what's at stake But in 2021, when when Congress passed a law And wrote in enhanced subsidies so people could get access to lower cost insurance plans that they were particularly low-income folks that made, you know, close to the cutoff.

Also get access to insurance.

Nobody had to pay more than 8.5% of income and health insurance.

So what's the impact on premiums if the subsidies these an extended or enhanced subsidies do expire?

>> Insurance companies are anticipating at this point that the enhanced something in some things are not going to continue.

And so they've already built in some rate increases into their proposed rates for the coming calendar year.

>> So rates are going to go up for folks.

>> And is there any way for Illinois ends to know how much they might have to pay in the ACA marketplace?

>> I yes, we are in the process sending and Roman notices everybody who's been on the market place in the last year and they will see in those notices exactly what the premium changes are going to be.

In addition, we will have as soon open enrollment starts November.

1st, we will have that information available on the get covered.

Illinois DOT Gov website as well.

So they will see what their premiums are going up too.

Okay.

>> News we're hearing about this November first deadline, of course, Democrat and some Republican lawmakers have called for the subsidies to be extended before open enrollment Congress meanwhile, has until the end of the year to extend the subsidies, some people that were getting notice of higher premiums.

news, what does this mean for people when they when they go to the market?

>> Well, of sorrow, sorry, I gonna come back to you and a promising news.

I want to get the the first thing they want keep in mind here is that.

But this market Carolina, 2014.

So we're talking 27 to go back to 2017 health insurance premiums have increased by about 66% over the period time.

But the consumer, the American, average American, has blunted from this because of the subsidies and now they're going to start dive starting to face the actual price that the actual harm about care prices and where the gone lately.

So this could be a bit of a shot enrollees when they come to the health care dot, Gov or a state-based exchange in November.

And they start seeing prices that premiums that could expand by 2 to 4 a factor for the big nervousness on the public health side is could this change the composition of enrollees entering the marketplace is could this make leave out?

People who maybe somewhat healthy, maybe it's not that this an opportunity to forgo health insurance altogether.

The individual mandate no longer in effect.

I if the pool get sicker, the war happened with the worry is what will happen.

The plans down the Do they have to further race but increased premiums to maintain to cover these costs?

And that could you know, introduce this concept of a death spiral where health insurance plans could just become not viable in this marketplace.

in the absence of the federal subsidies.

So there's a lot of concerns about what people are going to see on these websites in open enrollment.

Now, there's also the chance that millions could go without insurance a nationwide.

What are what are the numbers?

Tell us about Illinois and more specifically in Chicago.

Sure.

I know this is for colleagues over the Urban Institute.

>> They have a prediction of nationally.

We're talking about 5 million people about that.

Their their best estimate.

There's always uncertainty baked into these estimates.

>> 5 million people might be facing uninsured going on in short, among the 5 million for a look at drill down to state-level estimates in Illinois.

We're looking at something on the order magnitude the 100,000 people and in the Chicagoland area.

You look at congressional districts in Chicago.

anticipate something on the order of 60,000 people.

This is not small numbers, right for the context of state, major city and for the nation as a whole.

>> And the Department of Insurance, of course, he will administer get covered, Illinois, which is now a state based health insurance marketplace.

How could this be more flexible alternative for folks instead of the federal ACA marketplace.

>> There's a number of ways that we have more flexibility is a state-based marketplace.

One of the key ones is that we know run the navigator program for the people, the work with insurance or potential insurance to help them find coverage that fits their health care needs and their budget.

And that's critical.

This year as you're seeing these premium increases go on.

We want to make sure that people still reach out and talk to and the Gators don't assume there's nothing that you can forward because we have over 1000 different plan options available Internet.

Gators are here to work with you to try to customize a solution for you.

The other thing that we the flexibility to do now is to have special enrollment periods that we can control versus the federal government.

So too new ones we're going to be doing this year include a pregnancy special enrollment period.

If you become pregnant between open enrollment periods, you can sign up to still get coverage for at this special enrollment.

And we're doing easy enrollment, which is in collaboration with the Illinois Department of Revenue that there will be a check box on your tax return this year.

That allows you to indicate that you would like information about health care coverage and then we will reach out and follow up on that and get talking to a navigator broker to help you find something.

>> Taxes and health So Democratic Leader Hakeem Jeffries today he framed these ACA subsidies as part of the broader push for affordable health care.

Here he is.

>> I think what we've made clear is that you've got to cancel because lower the cost safe healthcare that involves addressing the Medicaid crisis that Republicans have created Medicare crisis, Hospitals, nursing homes, community-based health clinics closing all across the country.

And of course, extending the Affordable Care Act tax credits so that tens of millions of Americans don't experience dramatically increase health care costs.

>> Wendy, of course, you know this, this whole issue is at the crux of this government shutdown.

The second week we're in currently has the potential end of these subsidies, though.

Does it fit into the larger conversation about health care access under this administration?

>> So I think what we're looking at is need to have a global approach to this problem.

When we talk about we have a fractured health care system in the U.S., some folks are getting access to insurance through Medicaid, some for Medicare, some through their employer, some through these marketplace plans.

But we need to figure out how to get make sure that everybody has access to affordable coverage and the Republicans.

The Democrats just really disagree about how best to accomplish that.

The news, what are some of choices that some families might have to make when faced with these higher premiums when they go to market place.

>> I think there's really there's really 3. done 3 alternatives here.

The first is yet to find alternative source of coverage potentially.

But that seems unlikely as it is a noted already.

This is a group that's already not all.

They make too much income to be eligible for Medicaid.

And if they had an employer plan on the table, they would have taken it presumably because they wouldn't have been qualified for that.

The subsidies in the marketplace in the first So they don't this is seems like a potion that doesn't have a lot of other alternatives.

Are coverage.

So it's the second alternative.

Now maybe I pay through the nose on and pay this premium take insurance.

But the problem with that is I'm left with less income on the other end.

And we know we should go to some news.

Reports have highlighted change in the premiums as astonishing in over a year.

This is quite a quite a large sum of money, money that would have problems for these valleys, been spent on groceries, housing, home improvements, etcetera, childcare books as well.

the 3rd the option is go uninsured entirely, right.

So we've had now 2 to 3 decades of evidence from the Affordable Care Act.

And before that on the effects of insurance, what happens when people go uninsured?

Well, they use the health care system they get.

needed detections at less red lower rates.

So you may not find the cancer diagnosis that you need say mortality rates go up I financial protections go down.

Mental health does not.

does not go in direction either.

You have food security, more housing evictions rates.

So also it's a bad come as a result of that.

So no great options for families.

Lot of tough choices, OK?

That's