- Well, open enrollment for New Jersey's health insurance marketplace begins this week, but hundreds of thousands of residents could face staggering sticker shock, as federal subsidies for the health plans, which are the state version of the Affordable Care Act, hang in the balance.

Premiums on the marketplace are expected to jump nearly 175% next year, according to state data, putting coverage at risk.

State regulators warn many families may be forced to downgrade plans or go without insurance altogether.

The expected loss of the federal subsidies is tied to the ongoing budget standoff in Washington and the Murphy administration says it can't fill the gap if Congress fails to act.

For more, we're joined by Brittany Holum-Trundy, Research Director with New Jersey Policy Perspective.

Brittany, thanks for coming on the show.

I want to ask you first about the key factors contributing to these premium increases.

Why are they going up so much?

Excellent question.

Thank you.

So what we have here are enhanced premium tax credits that were introduced during the crisis of the COVID-19 pandemic that are now expiring.

So these credits helped people by improving affordability on the health insurance marketplace.

Here in New Jersey, it's called Get Covered NJ.

And they increased the amount of federal assistance that people with lower incomes received and provided assistance for people who were previously ineligible for federal assistance on the marketplace.

So that is where we are seeing the big jumps, because there are people who are losing some federal assistance and others who are completely losing federal assistance and will no longer be eligible.

But premiums, right, they were set to go up because of, you know, increased costs, inflation, right, increased drug price costs, including for some of the weight loss drugs that have become more commonplace.

It seems, though, like these subsidies make up a big share of that.

Just how much is the scale?

So yes, there were increases for health coverage rates anyway.

We have seen health care costs increasing over the last several years.

That has made affordability really difficult for many.

But these enhanced premium tax credits, again, they scaled assistance on the marketplace in such a way that there wasn't a subsidy cliff for people.

So that is where we are seeing the big jump in, there are, again, tens of thousands of people who are losing federal assistance altogether on the marketplace.

And so if you could, give us an example of what, say, an individual might see their premium increase for your regular health insurance plan.

So it depends on your county.

It depends on your income.

But for example, an individual who is older may see a couple of thousand in an increase, but they may also, if they are just over that eligibility level for these enhanced premium tax credits and so are no longer eligible for any federal assistance, they may see a jump of $20,000 per year if they are a couple.

It may be $10,000 per person.

So it really depends on the individual and their income and the plan and everything, but it's going to be thousands of dollars for most people.

And so then what's your chief concern, Brittany, for the, as I mentioned, about half a million people in New Jersey who are on the marketplace, for the folks who do rely on this to get health insurance?

My chief concern is that, as you've already pointed out, affordability of health care coverage is key.

And we've seen how important that has been from the protections that were introduced during the pandemic.

So these tax credits, the lowering of red tape barriers for Medicaid enrollees, we saw our uninsured rate go down during the pandemic.

We saw improvements.

And since those have started to roll back, we have seen more and more people becoming uninsured because they are just facing a terrible choice.

The coverage is becoming unaffordable.

And if they're having to spend 30 percent of their income on health care coverage, and then they spend over 30 percent on rent, they spend another chunk of it on utility bills, eventually, they've spent all of their income, and they haven't even paid for food yet.

And so that means they're going to end up having to make a choice about which bills to pay.

And oftentimes people will choose, unless they have a current medical emergency, they will choose to forego health insurance.

And then they face a greater risk of just insurmountable medical debt if they do face a crisis or emergency going forward.

How might this then affect enrollment numbers?

We've seen enrollment on the marketplace decline gradually.

How might this further affect that?

And then more broadly, just the overall stability of the market.

So we have seen enrollment improve where there have been affordability improvements.

And so as these protections are lost as the coverage becomes unaffordable, we will definitely see fewer people enrolling through the marketplace.

And again, many people will just go uninsured even if they are eligible because they cannot afford it.

And as we see numbers decreasing for the marketplace, we see more and more problems with health care prices going forward because the health care system is a complicated and yet delicately balanced system that really relies on people remaining insured and following up, having medical care in order to really keep everything affordable for everyone.

Brittany Holum-Trundy with New Jersey Policy Perspective.

Thanks so much for your time and your perspective.

Thank you.

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