SCOTT SIMON, HOST:
Millions of Americans now face higher health insurance costs. That's because open enrollment is happening right now on HealthCare.gov, and this year, there is a lot less federal money to help people pay their premiums. NPR's Selena Simmons-Duffin joins us. And we want to caution this story includes mentions of self-harm. Selena, thanks so much for being with us.
SELENA SIMMONS-DUFFIN, BYLINE: Glad to be here, Scott.
SIMON: What can you tell us about these higher premiums?
SIMMONS-DUFFIN: Yeah. Well, on average, premium costs are doubling this year, and that's because the enhanced premium tax credits that have been in place for the last few years are expiring. Hundreds of people have responded to NPR's call for stories about this. Some told us they have cancer or diabetes. Some are worried about losing access to medications that allow them to work. They're people of all ages and from all corners of the country. Something that shocked me this week that I learned has to do with call centers set up for people to call with questions about enrollment in these marketplaces. I found out there's been an uptick in callers threatening self-harm. Audrey Morse Gasteier, who runs Health Connector, the marketplace in Massachusetts, told the board that alarming fact in a public briefing earlier this month.
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AUDREY MORSE GASTEIER: The duress expressed by people reaching out to us in our call center to our navigators is profound. Individuals and families losing the help they depend on to afford to stay covered simply can't believe it.
SIMMONS-DUFFIN: She said they have a protocol for staff who take calls with people who threaten self-harm. They can potentially engage local law enforcement for wellness checks, for instance, and she said they're making sure staff have the support they need so they can take breaks to decompress afterwards. It's not clear how widespread this problem is. I asked the federal Department of Health and Human Services if HealthCare.gov call center staff were experiencing this, but I did not hear back.
SIMON: Selena, let me ask you how things go in the political arena. Could these subsidies be extended before the end of the year?
SIMMONS-DUFFIN: It is not looking likely. The Senate Finance Committee held a hearing this week, and one Republican senator described the party's positions as trench warfare. Republicans in the hearing really hammered the Affordable Care Act as a failure and floated new health reform ideas. Democrats said it's not the time for those debates. People need subsidies extended now. Here's how Democratic Senator Rafael Warnock of Georgia put it.
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RAPHAEL WARNOCK: If the health care system itself were a patient in a trauma room, it seems to me that we need to stabilize the system before we can explore innovative treatment options for long-term care.
SIMON: And, Selena, what was the Republican response?
SIMMONS-DUFFIN: You know, Republicans did not seem particularly moved by that argument. The Republican chair of the committee, Senator Mike Crapo of Idaho, put it this way.
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MIKE CRAPO: We cannot simply throw good money after bad policy.
SIMMONS-DUFFIN: He said the enhanced subsidies paper over rising costs and enable fraud. I also spoke to Brian Blase. He served in President Trump's first term and is now president of the Paragon Health Institute. He was a witness at that hearing. He told me why he doesn't think lawmakers should extend the subsidies even for a year.
BRIAN BLASE: They will say the exact same thing next year, that they just need the subsidies to continue.
SIMMONS-DUFFIN: He fears this will become an annual ritual, and the reforms he believes are critical will never get done.
SIMON: Selena, could that be politically risky, especially if voters living in Republican areas are affected?
SIMMONS-DUFFIN: Yeah, definitely. I mean, 3 in 4 enrollees in these plans live in states that President Trump won in the last election. I talked to Anthony Wright of the left-leaning health advocacy group Families USA recently, and he told me that even though Democrats didn't get an extension as part of the deal to end the shutdown...
ANTHONY WRIGHT: The understanding about these tax credits is now at a much higher level. And these have always had strong support, but that support only got stronger.
SIMMONS-DUFFIN: He says voters understand why their premiums are going up and that it's a policy choice Republicans are making. I should say there are some bipartisan plans in the works, but nothing concrete yet, and lawmakers have left town for the Thanksgiving holiday.
SIMON: NPR's Selena Simmons-Duffin. Thanks so much.
SIMMONS-DUFFIN: You're welcome.
SIMON: And if you or someone you know may be considering suicide or is in crisis, please call her text 988 to reach the Suicide & Crisis Lifeline. Transcript provided by NPR, Copyright NPR.
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