WASHINGTON — Americans can start signing up Friday for health care coverage offered through the Affordable Care Act marketplace for 2025, days before a presidential election that could threaten eligibility and raise costs for millions of those in the program.
The future of "Obamacare" emerged as a key issue in the closing days of the presidential campaign, with a top GOP leader promising this week to overhaul the program should Republican Donald Trump win the presidency.
Billions of dollars in tax credits are also at stake. Established during the COVID-19 pandemic, the money expanded eligibility for millions of Americans, made health insurance coverage more affordable for many and dramatically boosted enrollment.
Almost all of the 21 million people in the program benefited from those subsidies, which expire next year, U.S. Health and Human Services Secretary Xavier Becerra said.
People are also reading…
U.S. Department of Health and Human Services Secretary Xavier Becerra speaks Tuesday in Sacramento, Calif.
"Americans can actually look at health care not as a privilege, but now as a right," said Becerra, who planned a trip to the political swing state of Arizona on Friday to mark the beginning of open enrollment. "I don't think anyone wants to have a right yanked away from them to have affordable health insurance coverage."
Significant changes to the program are almost certain if Trump wins the White House and Republicans take control of Congress in Tuesday's contentious elections. They are threatening to scale back "Obamacare," a signature achievement of former President Barack Obama, a Democrat.
On Monday, a key Trump ally, House Speaker Mike Johnson, declared "No Obamacare" during a Pennsylvania campaign stop, promising "massive reform" under a Trump presidency with a Republican-controlled Congress.
"Health care reform's going to be a big part of the agenda," Johnson said in a video first obtained by NBC News.
Johnson's office later issued a statement saying he had no plans to completely repeal the landmark legislation, but the comments still underscored how Johnson is working closely with Trump to potentially remake the federal government and its social programs if Republicans sweep into power.
House Speaker Mike Johnson, R-La., speaks Sunday at a Trump campaign rally in New York.
Trump has only said that he has "concepts of a plan" to change the Affordable Care Act, which he was unable to successfully scuttle altogether during his previous term in office.
Enrollment under the Biden administration surged after years of declines during the Trump administration, dropping to a low of 11 million on Trump's watch. An infusion of billions of dollars more into the Affordable Care Act helped pay for subsidies to cut premiums by almost half for many of those enrolled in the program.
Congress would need to pass a new law to continue offering those subsidies, which could cost as much as $335 billion over the next decade. Some Republicans already balked at that figure.
Democrats caution voters that Republicans will try to revive an attempt to kill the Affordable Care Act altogether, with the warnings growing more dire as Election Day nears.
In Wisconsin, Vice President Kamala Harris issued the warning again, telling reporters that Johnson's remarks prove Republicans plan to gut the health care coverage.
"It has been a part of Donald Trump's agenda for a very long time," Harris said. "He has made dozens of attempts to get rid of the Affordable Care Act. And now we have further validation of that agenda from his supporter, the speaker of the House."
Former President Barack Obama speaks Monday at a campaign rally supporting Vice President Kamala Harris in Philadelphia.
The Biden administration expanded the program in other ways that Harris is likely to continue, but Trump is sure to pull back on. For example, the administration poured more money into hiring health insurance navigators who help enroll people into coverage.
The White House also implemented a new rule that expands eligibility for the program to immigrants who were brought to the U.S. as children. About 100,000 of those immigrants, also called "Dreamers," are expected to sign up for the coverage for the first time during enrollment this year.
Republican attorneys general in 15 states sued to block their enrollment.
Open enrollment for the coverage ends on Jan. 15, but to have coverage in the new year you must enroll by Dec. 15.
"I'd probably just die": 26% of employed Americans don't know how they'd cover expenses if they couldn't work for 3 years
"I'd probably just die": 26% of employed Americans don't know how they'd cover expenses if they couldn't work for 3 years
For many American workers, the period from November to mid-January is open enrollment season, when they can sign up for or renew employer-sponsored health and disability insurance plans. Though compared to health insurance, it's a valuable benefit that helps replace part of your income if you're ill or injured and can't work.
However, according to the Policygenius Disability Preparedness Survey, less than one-third (31%) of working U.S. adults currently have any long-term disability insurance (LTDI) at all, while 51% of those without disability insurance don't have it even though their workplace offers it.
At the same time, many working Americans are unprepared for an unforeseen illness or injury that makes it impossible for them to work. Twenty-six percent don't know how they would cover living expenses if they couldn't work for three years — a prospect that leaves some resigned: "I'd probably just die," one worker told .
Key findings:
- 26% of employed American adults don't know how they would cover their living expenses if they couldn't work for up to three years.
- 22% said they would either take on higher credit card debt or take out private loans to cover their expenses during an out-of-work period.
- Only 18% of employed U.S. adults are "very confident" that they could cover their expenses if they couldn't work for up to three years.
- 26% of middle-income American workers would take on some sort of debt to cover their expenses if they couldn't work for up to three years, and 45% are not confident they could cover their expenses during this time.
- 42% of middle-earning parents are not confident they'd be able to cover their expenses.
- Only 31% of employed U.S. adults have LTDI, either through their employer, a policy they bought on their own, or both.
- 58% don't have LTDI at all, and 10% aren't sure if they do or not.
- Of those who don't have LTDI, 49% say their employer doesn't offer it, while 37% of those whose employers do offer coverage didn't enroll in it because they can't afford it.
What we mean by middle income
For the purposes of this survey, middle income refers specifically to those workers with annual household incomes of $80,000 to $149,999. This spans most of the range that the defines as middle-income or middle-class: households earning between about $62,000 to $187,000 annually in 2022.
Many Employed Americans Don't Have a Safety Net if They Are Unable to WorkÂ
Roughly one in four employed Americans (26%) don't know how they would cover expenses if they couldn't work for up to three years. (The average length of a disability insurance claim is 34.6 months, according to the .) More than one-fifth (22%) would take on higher credit card debt or private loans. More specifically, 17% would increase their credit card debt, and 10% would open private loans if they were unable to work for three years.
On the other hand, 41% of employed Americans say they would live on their savings and investments, while 34% would live on the income of a spouse, partner, or another family member. Only 22% would rely on .
26% of Middle-Income American Workers Would Take on Debt if They Couldn't Work
Middle-income Americans are the most likely group of earners to take on debt if they can't work. More than a quarter (26%) said they would take out private loans or increased credit card debt if they couldn't work—greater than those with either higher or lower incomes.Â
This includes 25% of those with household incomes of $80,000 to $119,999 and 29% of those with household incomes of $120,000 to $149,999.
Half of Working Americans Aren't Confident They Could Cover Their Expenses if They Couldn't Work for 3 Years
Twenty-three percent of employed U.S. adults are "not at all confident" that they or their families could cover their living expenses if they were unable to work for this length of time, while an additional 26% are "not very confident."Â
Meanwhile, only 18% are "very confident" that they could cover their living expenses while out of work for three years.
Confidence in Financial Resources Is Shaky for Both Low and Middle-Income Earners
The average yearly household spending in 2022 was $72,967, according to the most recent from the Bureau of Labor Statistics. Given this figure and the years of inflation since then, it's not very surprising that only 14% of working Americans earning less than $50,000 a year are "very confident" they could cover their expenses during a long period of unemployment.
Many U.S. adults who are a part of middle-earning households aren't confident either. In all, 45% of employed Americans with a household income of between $80,000 and $149,999 are either "not at all confident" or "not very confident" about covering their expenses if they couldn't work.
This includes 47% of employed Americans with household incomes between $80,000 and $119,999 and 38% of employed Americans earning between $120,000 and $149,999, as well as 42% of parents in middle-earning households.
Generation X is the Least Confident About Covering Their Expenses, Though All Generations Are Similarly Pessimistic About It
Generation X (workers who were born from 1965 to 1980) is the least confident of the generation groups Policygenius polled about covering their expenses. Sixty percent of Xers aren't confident they could cover their expenses if they were out of work for three years, compared to about half of baby boomers and millennials and 37% of Generation Z.
Less Than a Third of American Workers Have LTDI, Even Though It Can Replace Lost Income for Years
If an injury or illness makes it impossible for you to work, LTDI may , usually until you're 65 to 67 years old; that's potentially millions of dollars in lost wages depending on your age and income.
American workers who have disability insurance tend to be more confident about covering their wages if they were out of work. Twenty-five percent of those with LTDI are "very confident" about covering their expenses, and another 37% are somewhat confident (62% combined, compared to 45% for those who don't have LTDI).
However, only 31% of employed Americans have an LTDI policy, including just 39% of U.S. workers who make between $80,000 and $149,999 a year, and 54% of those earning $200,000 or more—those whose potential lifetime earnings are highest and who therefore stand to benefit most from having coverage.
Among Uninsured American Workers, 51% Don't Have LTDI Even Though Their Employer Offers It
Of uninsured American workers whose , 37% didn't enroll in a plan because they didn't think they could afford it, including 32% of those with incomes of $80,000 or more a year. The same is true for 40% of parents and 29% of 18- to 34-year-olds—another group with high future earnings that benefits from having coverage.
Employer-provided disability insurance is often less than the , which is usually somewhere from 1% to 3% of the insured person's annual income.
What if your employer doesn't offer long-term disability insurance?
Private disability insurance usually costs more, but "it's always better to have some disability insurance coverage than none," says Patrick Hanzel, certified financial planner and Advanced Planning Manager at Policygenius. "But it's also important to find an option that fits into your budget for as long as you need it."
You don't want to pay more than you can afford for a policy and . Most disability insurance policies allow you to customize your coverage to maximize the features you need and remove the ones you don't, which can help bring down the overall cost of your policy.
Methodology
Policygenius commissioned YouGov Surveys to poll a nationally representative sample of 2,505 adults aged 18 and older, including 1,416 workers. The survey was carried out online from Aug. 22 to Aug. 26, 2024. Figures have been weighted and are representative of all US adults aged 18+. The average margin of error for responses is +/- 2%. Percentages were rounded to the nearest whole number, so some totals may not add up to 100.
was produced by and reviewed and distributed by Stacker Media.
Generation X is the Least Confident About Covering Their Expenses, Though All Generations Are Similarly Pessimistic About It
Generation X (workers who were born from 1965 to 1980) is the least confident of the generation groups Policygenius polled about covering their expenses. Sixty percent of Xers aren't confident they could cover their expenses if they were out of work for three years, compared to about half of baby boomers and millennials and 37% of Generation Z.
What if your employer doesn't offer long-term disability insurance?
Private disability insurance usually costs more, but "it's always better to have some disability insurance coverage than none," says Patrick Hanzel, certified financial planner and Advanced Planning Manager at Policygenius. "But it's also important to find an option that fits into your budget for as long as you need it."
You don't want to pay more than you can afford for a policy and . Most disability insurance policies allow you to customize your coverage to maximize the features you need and remove the ones you don't, which can help bring down the overall cost of your policy.
Methodology
Policygenius commissioned YouGov Surveys to poll a nationally representative sample of 2,505 adults aged 18 and older, including 1,416 workers. The survey was carried out online from Aug. 22 to Aug. 26, 2024. Figures have been weighted and are representative of all US adults aged 18+. The average margin of error for responses is +/- 2%. Percentages were rounded to the nearest whole number, so some totals may not add up to 100.
was produced by and reviewed and distributed by Stacker Media.
