MICHEL MARTIN, HOST:
It's been nearly a week since the federal government shut down after lawmakers failed to reach a budget deal. At the heart of the impasse is a partisan argument over if and when lawmakers need to act to extend subsidies for the Affordable Care Act marketplaces. Twenty-four million people who don't have insurance through their jobs or a public program like Medicaid use the system to buy health plans. We're going to get to some of the politics around this in a few minutes. But first, Julie Rovner is going to explain the substance of this funding impasse. She's the chief Washington correspondent for KFF Health News, which is a reporting partner of NPR. Julie, good morning. Thanks for joining us.
JULIE ROVNER: Good morning.
MARTIN: So let me just start with how this funding fight actually affects people. What is going to happen to people's average premiums if the health care subsidies expire at the end of the year?
ROVNER: They will more than double. That's according to a brand new analysis from my colleagues at KFF. For some people, they will go up even dramatically more because people at the higher end of the middle-income scale, if you will - over about $60,000 for an individual - will no longer get subsidies. Those would end for them. But everybody else would see substantial increases.
MARTIN: So that's the Democrats' argument - that if those tax credits to the Affordable Care Act, which was enacted under President Obama, are not extended, then health care costs are going to skyrocket. And the argument is that people are going to lose health care coverage because they can't afford it. Is that true?
ROVNER: Yes, and that's certainly what the Congressional Budget Office estimates - that about 4 million people would lose coverage because they could no longer afford it. In addition, the people who will continue to have coverage will pay more because insurers are going to try to make up for those people who will drop coverage, who are presumably healthier than average, by raising premiums for the people who are left in the pool. So everybody's going to be affected by this.
MARTIN: So let's turn to the Republicans. They are claiming that Democrats are trying to make sure health care is available to people who are in the U.S. illegally. And I have to tell you, I'm puzzled by this because people who are in the country illegally are not able to get coverage from federal programs. They can't buy health care plans on government exchanges. They can't receive any subsidies. So is there - and they're also ineligible for Medicaid, Medicare and all these other things. So is there any truth to that argument at all?
ROVNER: As usual, there's this little tiny sliver. It is mostly untrue. There's a program called Emergency Medicaid that pays hospitals to give emergency care to people who would be eligible for Medicaid but for their immigration status. So, yes, people who are here illegally. It's mostly used for labor and delivery. But also, if you have somebody walking around, even if they're here illegally, with a communicable disease, you want them to actually go and get treated so they don't spread it to others.
The Republicans' other argument is that there is a - there's waste and fraud and people who are illegally getting these programs because they lied about it, and that is likely true. There's waste and fraud in every program. But the Republicans have gone after that waste and fraud in such a way that they're going to cut not only the people who are cheating, but people who are still eligible are also going to get cut off of these programs.
MARTIN: So presumably, Republicans know that many of their constituents would experience these huge increases in their premiums. Is there a Republican position on these tax credits and extending them?
ROVNER: Well, that's the big irony. When these tax credits expire - and they were supposed to be temporary, and they were put in under the Biden administration - it's going to be mostly Republicans who are going to be impacted because it was in a lot of red states where the enrollment went up so much. So we saw Marjorie Taylor Greene just yesterday break with the rest of the Republicans in saying, we really need to continue these tax credits, because she recognizes that many of the people who voted for her are going to be hurt by this. We haven't seen that spread to the rest of the Republicans. At least, not yet.
MARTIN: Before we let you go, is there any current effect of this deadlock in Congress on people's ability to receive the medical care and services they need right now?
ROVNER: Not exactly. I mean, we're going to start to see, you know, some of the programs that are funded - not Medicare and Medicaid, the big mandatory programs, but things like community health centers could start to run out of money if this goes on much longer, and then we will see an impact. But for right now it's just a matter of fighting over when they're going to reopen the government and if and when they're going to re-up these subsidies.
MARTIN: That is Julie Rovner, chief Washington correspondent for KFF Health News, which is a reporting partner of NPR. Julie, thank you.
ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.
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