Why the ACA needs young people -- and the looming 'death spiral' for health insurance

[Dulcinea]

(NPR) Chloe Chalakani has a lot at stake in the health care fight at the heart of the government shutdown.

Chalakani runs a small culinary business with her partner in the coastal town of Thomaston, Maine. As temperatures drop and the height of her busy tourist season winds down, she's hitting her list of fall administrative tasks, including health insurance enrollment. 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.

https://www.npr.org/sections/shots-health-news/2025/10/26/nx-s1-5577940/health-insurance-government-shutdown-aca-open-enrollment-death-spiral

[Groundhawg]

1. You can't force young people in good health to be concerned about it.

[OC375]

2. Open it Up!

Once the employed/working Boomer cash starts to dry up, everything is going to need more money. By and large the rest of us lack the $$$ and head count to cover a lot of this stuff. Maybe this is what gets it opened up? Gen X is tiny, and people are generally having less kids. The tax base with $$$ is shrinking, so cuts are coming if we don’t figure it out.

[gab13by13]

3. Private Insurers will cut back on care/procedures.

My friend is one tough SOB, had his own saw mill, was in the lumber business. Recently a lady plowed through a stop sign and creamed his car. He almost lost his arm, his wife showed me a picture of it, it looked like it went through a meat grinder. His private insurance is making him go through 6 weeks of rehab before they will do a more costly procedure that his doctor was prepared to do. If this guy can't use his arm he isn't faking it.

My friend also has A-fib, he is out of rhythm but before getting a cardioversion to get him back in time his insurer says he must have a stress test. They pay a lot for their private insurance.

I have Medicare and have never had a problem with my procedures being questioned or denied. The people at the hospitals told me they love to handle claims from Medicare because there is never a problem. It is coming to Medicare. Krasnov wants to morph Medicare into Medicare Advantage and then I will be told what doctor I am allowed to see and my care will need pre-approved. I had one knee replacement and have scheduled my second knee because I can see what's coming. The Big Ugly Death Bill is designed to kill unwashed Americans like me.

[progree]

4. Some more from the article

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, ((so it's not just the insured and formerly insured that are hurt by this, it's everyone's healthcare --progree))

. . . 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.

(emhasis added)

I bet it's a lot more than 4 million losing health insurance.