How a Health Insurance Shortfall in Georgia Could Play Out in the Midterms

0:00At CLA, we're in your corner and on it. We coach tax strategies and Little League First Base. We help you adopt AI data tools and we adopt rescues named Buddy. We walk your factory floor and jog the local 5K, though sometimes we walk that too. Wherever you're coming from, we're right there with you. Wherever you're going, we'll get you there. CLA, CPAs, consultants, and advisors. Learn more at claconnect.com slash with you. So I'm using Georgia Access' state-based exchange website as a starting point, but you can actually do this at healthcare.gov. John Chakowsky is at his computer, scrolling through the options for health insurance in Georgia.

0:44I'm plugging in. I live in Fulton County, so I'm in downtown Atlanta. Here's my date of birth and then my income. Chakowsky is an independent insurance broker, and he's giving us a closer look at what he calls a double whammy. Premiums for insurance that complies with the Affordable Care Act, also known as Obamacare, have gone up. And federal tax credits that would have helped people pay for them expired on January 1st. Chakowsky saw the effects of this on prices and on the people he helps find insurance. Seeing the rates increase year over year, that's kind of par for the course. Seeing the rates jump overnight from one year to the next, that significant, you know, 30 to 40 percent, that was a shock to the system.

1:31Most people were not expecting the shift to be that dramatic. And this last open enrollment, like, eyes were wide open. I had people in tears saying, I can't pay for this. I'm going to have to go uninsured.

1:50Some subsidies are still in place, but Congress allowed enhanced Obamacare subsidies doled out during the COVID-19 pandemic to lapse, a fight so bitter it led to a government shutdown over whether or not to extend them. Providing those subsidies obviously comes at a cost for the U.S. government. A Congressional Budget Office analysis from September found that a three-year extension for them would have cost the federal government roughly$90 billion. But losing those subsidies has been tough for a lot of the people Tchaikovsky works with. He calls the latest period of health insurance signups the hardest one he's seen in his 17 years on the job.

2:29The health research nonprofit KFF estimates that on average, the expired subsidies mean that annual premium payments for ACA marketplace enrollees will more than double, from an average of$888 in 2025 to roughly$1 ,900 this year. Tchaikovsky says that in a few cases, he saw families' premiums triple. A lot of people were flat out upset, devastated in some cases. I'm Sabrina Siddiqui, and this is What's News Sunday. Over the last few weeks, I've been reporting on how the rising cost of living could determine who controls Congress next year. In this episode, we talk to some of the Georgians navigating higher health care costs, and to the pollsters who work with The Wall Street Journal to tell us what those costs might mean ahead of statewide primary runoff elections coming up this Tuesday.

3:23This is the Cost of Living Election Part 3.

3:30According to the Georgia Recorder, the Peach State has seen a 37 % drop in Affordable Care Act enrollment since the start of last year. That represents more than half a million Georgians in a state of roughly 11.5 million. And data from the U.S. Census shows that, a few years ago, Georgia had one of the highest rates of residents under 65 without insurance, at 13.6%. Joey Bernard is one of them. He would have gotten insurance through Georgia Access this year, but it was too expensive. The prices we were seeing on the Georgia Access website was going to be about a third to a little under half of our monthly budget and everything, and I couldn't justify it.

4:12Bernard is 40, and he lives with his wife and daughter in the city of Ball Ground. It's in Cherokee County, which isn't far from Atlanta, though far enough from that urban center so as to be solidly Republican. At the presidential level, the county hasn't voted for a Democratic president since Georgia's own Jimmy Carter. For Bernard, the premium costs on marketplace insurance just weren't sustainable. Basically seeing$800 one night and then the following day or the next day or so and seeing$1 ,600 and$2 ,400, I was like, are you kidding me? I shook my head and I was like, there's no way. This can't continue.

4:52This is outrageous. Last year, Bernard was laid off from the IT job he'd worked for 15 years. He's found work again, but his new job doesn't provide health insurance like his old one did. Now he and his wife are setting money aside to pay out of pocket for any medical attention they might need. We've taken the money that otherwise would have been spent for insurance and just using it for straight up cash and just, you know, kind of hoping and praying that, you know, nothing catastrophic happens for right now until we can find something more reasonable for our family. For some other Georgians, the higher cost of health care is already leading to tough choices.

5:32We haven't been going out. We've been doing meatless Mondays. To be frank, other expenses have gone up as well on top of insurance. Elizabeth Barnett lives with her husband, daughter, and grandfather in Stone Mountain, Georgia, also near Atlanta. For a while, she was uninsured. We spent several years where we were not in the financial position to take care of our health and even have insurance at all. That changed when her husband started a job as a paramedic, which provided her with health insurance. During the pandemic, she took advantage of the more affordable marketplace insurance to tap into a broader network of doctors.

6:10Those costs have gone up, so she's back on her husband's insurance. Barnett has to see a cardiologist because heart issues run in her family. Her coverage to see that kind of specialist isn't great, so she doesn't visit him as much as she'd like. The price went up and the coverage went down. We're having to plan and micromanage our budget to be like, okay, well, can we afford to see the cardiologist or are we going to have to, you know, push it out and just hope for the best? Because to be frank, I cannot afford a$500 doctor visit to see a cardiologist. Joey Bernard and Elizabeth Barnett are both paying attention to the elections coming up in Georgia.

6:54The state holds runoff elections this Tuesday. One race will decide which Republican challenger will take on Democratic Senator John Ossoff for his seat in November. Ossoff will have to motivate people like Barnett. We'll be voting Democrat. Pretty much have only ever voted Democrat, actually. While also pulling over people like Bernard. He's leaning toward the Democrats this time around, even though he's voted Republican in the past. We've had a rash of a lot of Republicans recently the last number of years here where I live and in Georgia in general. And things just do not seem to have gotten significantly better for me or my family and a lot of my friends and co-workers.

7:32So that's why I just feel like, OK, you know, maybe it's time to swing to the other side for this round. Coming up, I talk to a pollster from each party to ask what they've seen and how voters in Georgia and across the country are responding to increased health insurance costs. We, in a way, are giving voice to people and their opinions and attitudes, and that's really important. That's after the break.

8:08This podcast is brought to you by Federated Hermes. We put our investments through a ruthless vetting process because the market can be unpredictable and we don't think your investments should be. Learn more at federatedhermes.com slash US. Investments are subject to risk and may lose value.

8:29Here at the Wall Street Journal, we don't just report on the results of polls. We also work with pollsters to conduct some of our own. As a national politics reporter at the paper, I always appreciate a conversation with those pollsters. I'm joined now by Adam Geller and John Anzalone, our Republican and Democratic pollsters, respectively. Adam, hello. Great to be here. Thanks for having me. John, hello. Hey, Sabrina. John, I want to ask you first, a lot of the voters we talked to didn't have much faith in politicians' ability to offer real solutions to the growing costs of health care. But is one party more trusted than the other on that issue?

9:09Yeah, you know, it's one of the rare issues where Democrats actually have a trust advantage over Republicans. We've seen that consistently on health care. But I think that there's actually a broader problem in terms of how people feel that the political and financial systems in this country are stacked against you. Right. In our poll from May, it was basically three quarters of respondents who said they felt the economic and political systems in the U.S. are stacked against people like that. Right. And so the trust level, there's an impediment there. But we can talk about what people think politicians can actually fix.

9:45And that's where it gets really kind of interesting. And our January Wall Street Journal poll, health care was right up there with groceries. But when we ask a separate question about what do you want the president in Congress to make a priority, health care beat out groceries by 20 points, which kind of tells you that they think that there's something that they can do about health care, but maybe not so much about groceries. Adam, John was just talking about that Wall Street Journal poll in January. A vast majority of voters also expected their premiums to rise, 70 percent. More people said they would blame Trump administration policies, 44 percent, compared to health insurance companies.

10:22That was just 27 percent for their premiums going up. So how much of a liability is this issue for Republicans? And has anything changed since January? Has it gotten better or worse for Republicans? Wow. I mean, there's a lot there. And the reality is, John is right. Let's start with the basics in terms of which party voters trust more. Democrats absolutely have the advantage on health care. President Trump is a easy target for partisan Democrats, most of whom are united in blaming him. Republicans don't have an easy target such as Trump. And so what happens is independents and Republicans split blame a little bit more evenly.

11:13Insurance companies get some of the blame. Previous administrations get some. And yes, the current administration also gets some. But within premiums going up, one of the things that really stuck with me was the woman who said she couldn't afford the$500 that the cardiologist was going to cost. Well, in our most recent May poll, we asked this very question about whether you could actually afford a$500 surprise bill. That could be healthcare. It could be tires. It could be a water heater. and 34 % of Americans say they could not come up with$500, that kind of tells you the financial anxiety that people are dealing with right now.

11:54And Sabrina, can I just add that Democrats have an advantage, but only if they talk about healthcare the right way. We heard a lot about ACA subsidies, Medicaid cuts,$35 insulins, prescription drugs. Democrats tend to focus on those things instead of the 70 % of people who have private health insurance. And in some of our internal polling, this isn't necessarily Wall Street Journal polling, those things that tested with incredible intensity because they met people where they were had to do with things that they deal with every day. We find that it's one, it's health insurance costs. And two, the other big thing is they don't feel like they're getting what they pay for.

12:37They want to require health insurance companies to cover the treatments and procedures that doctors prescribe. And they always are getting denied. And those two things, health insurance costs ranked at like 43 percent, requiring health insurance companies to cover treatments their doctors asked for is at 38 percent. Lowering prescription drugs and copays was actually down at 7 percent. And it seems like that's all Democrats and Republicans want to talk about. Right. And so a lot of times they're not talking about the right thing. That's a really interesting point because Republicans have long talked about replacing the Affordable Care Act with something else, though it's not always clear what.

13:17Meanwhile, for the Democrats, in recent years, the idea of Medicare for all really gained traction among progressives, but it's not something that the party is touting so much anymore. Adam, how do the party's visions differ on health care? Well, it's dollars and cents. The way in which the parties split on this has to do with the cost, the deficit when it comes to public funding and taxpayer costs. There's an element of potential fraud or perhaps even known fraud when it comes to who's eligible for some of these subsidies or who might even be eligible for other kinds of health care issues. It's not just illegal migrants, which I know sometimes it's easy to break it down in terms of that's the Republican argument, but it's also people whose income far exceeds what it really should be in order to be eligible for such things.

14:12So I think the real concern with fraud and potential for fraud is something that Republicans are looking at, but it's really easy then to message against them to say, well, in the meantime, this is what you're cutting for working people who can use it. And it's a compelling message and a strong one. John, the subsidies were such a source of contention. I covered it very closely. Democrats shut down the government in a bid to try and extend the subsidies. And some might argue that they caved in that fight because ultimately, in order to reopen the government, they secured a vote on the subsidy issue.

14:48But it was very clear that there was no deal in place to extend the enhanced subsidies. And so do you feel like voters, especially Democratic voters, believe that the party has done enough on health care that they really did everything they could to try and protect these subsidies since they impact such a large share of voters? Yeah, I do think that this is kind of like an opinion elite versus real voter. You know, I mean, I think, you know, your segment was in Georgia. I think John Ossoff, Senator Ossoff, is going to benefit by the fact that he's fighting to restore those cuts to ACA or restore cuts to Medicaid.

15:30When you take in Georgia, for example, I think 10 % of the populace is on ACA, 20 % on Medicaid, that's 30%. And they're going to believe John Ossoff on those issues a hell of a lot more than Republicans because they know that Republicans are the ones who cut both of those. So I think we're on firm ground. And I think that whether we went far enough or what was the pain threshold before you gave in and things like that is more of an insider argument. Adam, what are the candidates saying on the subsidy issue, especially Republican candidates this election cycle? It just feels like there's been a little bit of light messaging when it comes to that, as the Republicans have really focused on each other and getting through the runoff.

16:21And that, I think, really does back up John's point that Senator Ossoff, in the meantime, is the beneficiary because he has a really easy message to put out there in terms of what he's fighting for. And I would say that from a Democratic consultant, there's two groups to really focus on. Women are the health care deciders. They deal with their own individual health care problems. They deal with their kids. They often deal with either their parents or their in-laws. And number two, seniors are very health care sensitive. They just have a little bit more time. They're just in a little different stage of their life.

17:04And seniors have become much more of a persuadable or swing universe starting in 2020. President Biden in that year moved the gap down from Trump's previous election in 2016. And these are really astute voters. Women voters, especially suburban women voters and older voters, will pay a lot of attention to the health care issue. John, Adam, thank you so much for being here. Thank you for having us. Thanks, Sabrina. The Cost of Living Election is part of the Wall Street Journal's What's News. This episode was produced and mixed by Pierre Bien-Aimé. Michael LaValle wrote our music. Editorial oversight from Joshua Jamerson, Chris Inslee, and Tali Arbel.

17:49I'm Sabrina Siddiqui, and I'll be back soon with the last installment of The Cost of Living Election. Thanks for listening.

18:03our real world experience that delivers. FTI Consulting. Experts with impact.