The amount of government help Nathan Auldridge is getting to pay for health insurance will more than double in 2018. The Salem, Virginia, resident doesn't like that he will cost the government $457 a month in premium tax credits.
He doesn't feel guilty about it either.
Auldridge makes between $9 and $12 an hour as an in-home support provider for people with disabilities. He's paid through an agency funded in part by Virginia Medicaid.
"If the government paid me more than $9 to $12 an hour for my work, I might not require subsidies for my health care," he said.
Auldridge has three clients. He works from 2 p.m. to 11 p.m. most weekdays. He's so busy it wasn't until he went home to Ohio for Thanksgiving he got to sit down and shop carefully for health care on HealthCare.gov.
Nathan Auldridge is receiving a $457 monthly health care subsidy in 2018. (Courtesy of Nathan Auldridge)
Higher premiums, bigger subsidies
Auldridge isn't alone in getting a bigger tax credit for health care in 2018.
President Donald Trump ended government payments to insurers known as cost-sharing subsidies earlier this year. These payments reimburse insurers for lowering the out-of-pocket payments of low-income patients. Many insurers raised premiums to offset the end of the subsidies, but, at the behest of savvy state insurance commissioners, front-loaded those increases onto silver plans. The price of a silver plan sets the other big subsidy in former President Barack Obama's health care law: the premium tax credit. As a result, people who qualify for the credit are getting more financial aid.
Many people who don't qualify for subsidies, conversely, are confronting high price tags.
Although Auldridge is getting a subsidy that is more than twice as large, he's only paying $20 less a month in 2018 because premiums shot up so much.
Saving thousands through the health law
Auldridge doesn't get health care from his employer. He earns a low income, which "doesn't give me a whole lot of wiggle room," he said.
Auldridge didn't set out to become an in-home support provider. He studied theater in college. But he needed a steady job to help pay for health care costs.
In January 2006, doctors at Duke University removed a tumor from Auldridge's brain. He developed narcolepsy as a result of the tumor, a pre-existing condition that sent his health costs skyrocketing. In 2013, before the "Obamacare" exchanges launched, he paid $483 a month in premiums, plus $1,203 a month for narcolepsy medication and $200 for cholesterol medicine until he reached a $5,000 deductible.
In 2017, Auldridge paid $10 a month for his medicine. While his premiums for 2018 are lower, his prescription copay will rise to $15 each month. His 2018 costs are still a fraction of what he paid in 2013.
That year, his monthly premium was $483, compared to $44 a month for 2018. He estimates Obamacare has saved him $35,000 since the exchanges launched. In 2013 alone he spent more than $10,000 on health care. In 2018 he expects to pay less than $1,400.
'A chaotic world'
Auldridge, who considers himself very liberal, hopes the individual mandate, which requires all Americans to get health insurance or pay a penalty, survives Republican attempts to repeal it. He fears the marketplaces will fall apart without healthy people having financial incentive to sign up.
"I understand how insurance works," he said. "They take the premiums from a large pool of people to pay for the medical costs of everyone in that pool."
He's not confident in Congress preserving the law. Auldridge has spoken to his local congressman, U.S. Rep. Morgan Griffith, but the Republican has consistently come out in favor of repealing Obamacare.
Griffith said he has known Auldridge for a long time, but that most of his constituents haven't benefited from the health law in the same way.
"Their rates have risen, their deductibles have risen, and they have not been able to keep their doctors, which in a rural area like the Ninth District means some have to travel more than an hour to see the new Obamacare plan-authorized doctor," Griffith said. "Nathan’s situation and those of others who were benefited are the reason I want the replacement to still cover people with pre-existing conditions.”
Virginia did not expand Medicaid, but could next year after the 66-seat majority held by Republicans in the state legislature was eroded down to 51-49 in the November election. A Dec. 19 recount threatens to erase the majority entirely.
Auldridge isn't sure what will happen to the health law in a year. It's hard to know whether he should be more worried about nuclear war than health care, he said.
"It's just a chaotic world with Trump as president," he said. "It's not easy to predict anything."
This is the sixth in our series profiling real people who use the Affordable Care Act. We're hoping to put a face to the controversial law and provide an up-close look at its impact, whether harmful or helpful. We'll feature someone new each week until federal open enrollment ends on Dec. 15, so check back for more stories. If you're looking for help signing up for Obamacare 2018, visit our HealthGenius section.