At 59, Susan Wood, a longtime Boise, Idaho, resident, was too young to qualify for Medicare when she retired in July. So she signed up for a marketplace plan under the Affordable Care Act, often called Obamacare.

But in the months since, the federal government’s proposed changes to health insurance have threatened to upend her planning — and that of thousands of Idahoans and Americans, she warned. Federal subsidies she relies on are set to expire at the end of the year, and Congress is at an impasse over whether to extend them.

Wood spent decades working in the insurance industry and knows it well, she said. Over the years, she held jobs in Medicare and group health insurance, opened up her own long-term care agency and trained insurance agents. She picked a “middle-of-the-road” insurance plan from the marketplace with a high deductible, she told the Idaho Statesman. With the help of federal subsidies, which get paid out to insurance companies, she has to cover only $72 of her monthly premium.

Wood said she’d be on the hook for her plan’s full $700 monthly premium without the subsidies. Those payments would surpass what she spends on her mortgage or on food.

Congressional Democrats’ budget proposals would preserve the Obamacare tax credits, which were extended to higher income households in 2021, and undo Medicaid cuts Congress passed over the summer. Their measure would add more than $1 trillion for health care programs; Republicans have sought to keep spending levels flat, in part by letting some of the insurance subsidies expire. The disagreement is at the heart of a federal government shutdown that began Oct. 1.

While Wood can afford the payments, many people, especially those who are young and healthy, will likely choose to drop insurance plans rather than pay higher premiums, she said. With a smaller, sicker pool of people left to insure, companies will be less able to spread out their risk and cost — and they’ll almost certainly further raise their premiums.

“People are going to die,” Wood said. “People are not going to be able to receive care that they need.”

Without the subsidies, the nearly 25 million Americans enrolled in marketplace insurance coverage will face higher insurance premiums next year. Five million of those will lose coverage entirely, according to Keep Americans Covered, a coalition of medical associations, insurance companies and hospitals.

In Idaho, a 55-year-old earning about $63,000 per year will see annual premium costs rise by an average of nearly $4,000, according to the Center for American Progress, a nonpartisan progressive policy institute.

“There is no phase-in for the looming cost cliff facing the millions of people who buy insurance on their own in the individual market,” Keep Americans Covered wrote. “This is not something looming after the midterm elections; it’s coming quickly.”

‘Unimaginable,’ ‘unaffordable’ insurance premium spikes

Bob McMichael, a retired professor and high school English teacher north of Boise in Council, and his wife, a retired surgical technician, wanted to get their next annual health checkup scheduled, but they couldn’t get it booked until January. By then, McMichael told the Statesman, they may not be able to afford it.

A few years after they retired, but before they were eligible for Medicare, McMichael, 63, and his wife, 62, got the cheapest plan they could find on the marketplace. It had monthly premiums of about $1,800, but Obamacare subsidies kept their monthly payments to about $50 a month.

In October, McMichael got a letter from the plan that warned of monthly premiums jumps next year. The letter didn’t give a reason, but analysts say insurance companies are planning ahead for a diminished pool of users as more Americans opt out of health insurance amid the loss of government subsidies. He would face costs of over $2,200 a month — $400 a month with the subsidies. If the subsidies also disappeared, he and his wife would be spending most of their monthly income on a “really crappy health plan,” he said.

“It is absolutely and totally unimaginable, not to mention unaffordable,” he said of losing the subsidies.

If that happens, he and his wife plan to drop their coverage, he said. He hopes they’ll find a cheaper plan on the market, but he’s not optimistic. The plan they chose last year was the most affordable option for them, “other than not to have health care.”

Idaho Republican U.S. Rep. Russ Fulcher, and U.S. Sens. Jim Risch and Mike Crapo did not immediately respond to requests for comment. Lexi Hamel, a spokesperson for U.S. Rep. Mike Simpson, referred the Statesman to Simpson’s comments in a previous interview with KTVB. He said Republicans’ proposal did not eliminate all tax credits for health care, but just for people with higher incomes. Maintaining the current level of funding for the tax credits would be “very, very expensive” during a period “when we’re trying to reduce the deficit.”

“We’ve got to head this country in a different direction,” Simpson said.

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