COLUSA, Calif. \u2014 Early on, Jean Franklin got some career advice she followed religiously: \u201cPay yourself first.\u201d So she did, socking away hundreds of thousands of dollars in retirement savings by the time she became a stay-at-home mom at age 41.<\/p>\n
She and her husband, Charles, a former high school teacher who goes by Chaz, planned to retire comfortably in the three-bedroom house where they raised their kids about 60 miles northwest of Sacramento.<\/p>\n
But early last year, the 63-year-old became unsteady on her feet. One morning in May, she woke up with slurred speech and landed in the hospital, then rapidly lost the ability to move the right side of her body.<\/p>\n
In August, as doctors continued to puzzle over a possible diagnosis, the couple received a notice saying that on Jan. 1 their combined health care premium payments through the state insurance exchange<\/a> would shoot up from $540 a month to $3,899 a month. The reason: Federal enhanced premium subsidies expiring at the end of last year would no longer offset their payment.<\/p>\n They immediately canceled a monthlong cruise they\u2019d been planning with friends and looked through their retirement accounts.<\/p>\n \u201cNow, instead of thinking about where we can go in our retirement, we\u2019re asking the question, \u2018Are we still going to be able to stay where we are because of the health care costs?\u2019\u201d said Chaz, who retired in 2021 at age 59.<\/p>\n Then they received more bad news. In October, at the age of 63, Jean was diagnosed with ALS, a debilitating disease that will eventually leave her unable to speak, swallow, or breathe on her own<\/a>. But Jean\u2019s condition allowed her to enroll in Medicare, the federal health insurance program that covers adults 65 and older and people with disabilities. The diagnosis saved them roughly $1,600 a month in premiums \u2014 little comfort as Jean lost her ability to walk, bathe, and dress herself.<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t<\/p>\n \u201cIt\u2019s kind of morbid that, because of my diagnosis, I got put on Medicare right away, so at least we don\u2019t have to pay that out-of-pocket,\u201d Jean said, sitting in a wheelchair in her living room, a quilt draped over her legs to guard against the intense chills she now often gets. \u201cWe\u2019re not going to get buried under this.\u201d<\/p>\n Yet the premiums for Chaz\u2019s plan and her Medicare remain a significant strain on their finances. The $2,300 a month they now owe, which includes roughly $342 in premium payments for Jean\u2019s Medicare supplemental insurance, is higher than their monthly mortgage and eats up more than a quarter of their budget.<\/p>\n The Franklins are among the 22 million people<\/a> across the nation facing greater financial pressure<\/a> after Congress chose not to extend 2021 enhanced federal subsidies. That assistance helped more than double enrollment in Obamacare plans to over 24 million.<\/p>\n The Congressional Budget Office estimated in 2024 that, without an extension of the tax credits, the number of uninsured Americans would climb by 2.2 million this year alone. As of January<\/a>, nationwide enrollment in ACA plans was down about 1.2 million year over year, though experts say it could be months<\/a> before the full effects of rising premiums are known, as people miss payments and lose coverage.<\/p>\n The groups hit hardest will be early retirees<\/a>, middle-income earners<\/a>, and people living in high-cost states, said Stacey Pogue<\/a>, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University. The Franklins are all three.<\/p>\n \u201cThey fell off what we call a subsidy cliff,\u201d Pogue said. \u201cIt\u2019s very, very shocking, the amount that a person would have to absorb.\u201d<\/p>\n That\u2019s because the expanded tax credits made the biggest difference for people nearing retirement age who sat just above previous income eligibility<\/a> thresholds, Pogue said. People such as the Franklins, who likely wouldn\u2019t have qualified for financial help before expanded credits were implemented, are now losing that support at a time when insurers have responded to the uncertainty by dramatically raising rates.<\/p>\n Roughly half of people who were expected to lose eligibility for premium tax credits were ages 50 to 64, according to an analysis by KFF<\/a>, a health information nonprofit that includes KFF Health News.<\/p>\n Republicans who opposed the extension have said the premium assistance went directly to insurance companies rather than consumers, incentivizing fraud and wasteful coverage. They also say the enhanced subsidies, which had no upper income limit for eligibility, were far too generous in capping premium payments at 8.5% of income, no matter how much an enrollee made.<\/p>\n \u201cMost Americans would agree that taxpayers should not be subsidizing the health insurance of someone making $250,000,\u201d U.S. Rep. Ken Calvert<\/a>, a California Republican who voted against<\/a> an extension in January, wrote in an Orange County Register op-ed<\/a>. \u201cI cannot accept the simple extension of a program that will line the pockets of insurers and is riddled with fraud at the expense of the American taxpayer.\u201d<\/p>\n Patient advocates say the premium increases and expiration of subsidies have forced people into difficult choices. \u201cThe young people who are healthy are the first to say, I\u2019m going to roll the dice\u201d and forgo coverage, said Rebecca Kirch<\/a>, executive vice president of policy and programs at the National Patient Advocate Foundation. \u201cThose who are remaining in the system \u2014 because they have no choice \u2014 are holding off care, they\u2019re holding off their meds, they\u2019re going without necessary food.\u201d<\/p>\n While the Franklins are getting by, they have relied on their sons to pay for a motorized recliner to assist with lifting Jean and a handicap van to transport her. Chaz, who broke a tooth a year ago, delayed fixing it because a crown would cost him $1,000.<\/p>\n This year, the couple will draw $36,000 more than they had anticipated from their retirement savings, most of it to cover Chaz\u2019s insurance premiums.<\/p>\n \u201cI have a nest egg,\u201d Chaz said. \u201cBut there\u2019s a lot of people around here who don\u2019t.\u201d<\/p>\n For a while, he was outraged.<\/p>\n \u201cI wish Congress would get off their butts and solve this issue,\u201d said Chaz, who is a registered Republican but blames both sides of the aisle. \u201cYou\u2019re so busy bickering over stupid crap and it\u2019s both parties pointing fingers and blaming. Where was this discussion two years ago?\u201d<\/p>\n Now, Chaz said, he\u2019s focused on making Jean, his wife of 27 years, as comfortable as possible.<\/p>\n Before she got sick, they did practically everything together \u2014 hiking, traveling, tai chi, amateur photography, and bug-hunting. One of her favorite specimens was the rain beetle, a fuzzy scarab-like insect that can\u2019t feed as an adult, relying solely on fat stores from its larval stages.<\/p>\n In the mornings, Chaz and their sons, Charlie and Louis, take turns lifting Jean, dressing her, and helping her use the bathroom. It\u2019ll be fodder for the counselor, she jokes to her sons, when they inevitably need therapy later in life.<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t<\/p>\n Most days, Jean\u2019s outdoor adventures rarely extend beyond being wheeled to her back patio, where she loves to watch their backyard chickens bobble around. Chaz\u2019s stubbornness makes him a great patient advocate. Charlie always seems to know exactly when she needs a big hug, and Louis tells jokes that can still make her snort with laughter.<\/p>\n \u201cI don\u2019t know what I would do without my boys making me laugh,\u201d she said.<\/p>\n In December, Chaz will turn 65, old enough to qualify for Medicare himself. \u201cAfter this year \u2014 knock on wood \u2014 we should be OK,\u201d Jean said, before pausing and shooting her husband a wry smile.<\/p>\n \u201cWell, you\u2019re gonna be OK.\u201d<\/p>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage?\u00a0Click here<\/a>\u202fto contact KFF Health News and share your story.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n