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Why the ACA needs young people -- and the looming 'death spiral' for health insurance, NPR, 10/26/25
Chalakani runs a small culinary business with her partner in the coastal town of Thomaston, Maine. . . . She uses CoverME.gov, the Affordable Care Act marketplace in Maine, also known as Obamacare. Her options for 2026 are looking grim.
"My premium is already $460 a month, and that is for the highest deductible plan that exists," she says. She's 31 years old and fairly healthy. Extra financial help with premiums — in the form of enhanced tax credits — expires in December, and rates are going up. "I don't plan to get insurance next year," she says.
. . .
Health insurance markets only function when there are lots of people pooling their resources — young and old, relatively healthy and not. "You need people to be paying into the insurance system when they're healthy so that they can take out when they're sick," explains Cynthia Cox of KFF, a nonpartisan health research organization.
. . .
If Congress does not extend the federal subsidies set to expire in December, the Congressional Budget Office estimates that 4 million people will become uninsured in the next several years.
The people who opt to go without insurance will probably be younger and healthier,
. . .
"If hospitals face a lot of financial strain from having a lot more uninsured patients coming through their doors, then they might start changing the services they offer," she says. "They may have to close the maternity ward. They might have to close down altogether." That's already starting to happen in Maine and other parts of the country,
. . . Meanwhile, open enrollment is coming on Nov. 1 — in Idaho, it's already begun. Unless Congress acts quickly, enrollees will likely have sticker shock when they log in to find a plan for 2026. On average, consumers will have to pay double next year for the same plan.
More: https://www.mprnews.org/story/2025/10/26/npr-health-insurance-government-shutdown-aca-open-enrollment-death-spiral
(emhasis added)
"My premium is already $460 a month, and that is for the highest deductible plan that exists," she says. She's 31 years old and fairly healthy. Extra financial help with premiums — in the form of enhanced tax credits — expires in December, and rates are going up. "I don't plan to get insurance next year," she says.
. . .
Health insurance markets only function when there are lots of people pooling their resources — young and old, relatively healthy and not. "You need people to be paying into the insurance system when they're healthy so that they can take out when they're sick," explains Cynthia Cox of KFF, a nonpartisan health research organization.
. . .
If Congress does not extend the federal subsidies set to expire in December, the Congressional Budget Office estimates that 4 million people will become uninsured in the next several years.
The people who opt to go without insurance will probably be younger and healthier,
. . .
"If hospitals face a lot of financial strain from having a lot more uninsured patients coming through their doors, then they might start changing the services they offer," she says. "They may have to close the maternity ward. They might have to close down altogether." That's already starting to happen in Maine and other parts of the country,
. . . Meanwhile, open enrollment is coming on Nov. 1 — in Idaho, it's already begun. Unless Congress acts quickly, enrollees will likely have sticker shock when they log in to find a plan for 2026. On average, consumers will have to pay double next year for the same plan.
More: https://www.mprnews.org/story/2025/10/26/npr-health-insurance-government-shutdown-aca-open-enrollment-death-spiral
I bet it's a lot more than 4 million losing health insurance.