By Dave Ress
Richmond Times-Dispatch, Va.
(TNS)
Thinking about a looming spike in Obamacare premiums, one hospital head fears a replay of the jump in cancer cases that followed the COVID-19 pandemic.
The price of coverage under the Affordable Care Act will jump between 30% and 50% if Congress does not act to extend the enhanced premium tax credits that helped keep down insurance costs during the pandemic, says Lance Jones, chief executive officer of Chippenham and Johnston-Willis hospitals.
That bad news, he warns, is going to hit Nov. 1, when open enrollment for Obamacare coverage starts, even if people aren’t thinking about it now.
But the bad news that he fears, and what reminds him of the post-pandemic months, starts in January. That is when, if Congress does not extend the tax credit—as it so far has declined to do—many of the more than 388,000 Virginians with Affordable Care Act policies could drop coverage.
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“We saw this post-COVID,” he said. In response to the pandemic, people who feared “catching something” decided to avoid being around other people, Jones recalled.
“They delayed tests, they chose not to go through screenings.”
“And as we came out of the COVID challenge, all of a sudden, health conditions that had been not as present or not as significant during that time period … started to reveal themselves.
“And cancer, frankly, was probably the most prevalent. Folks put off screenings, didn’t get mammograms, didn’t get colonoscopies, etc. And we saw an incidence rate where things accelerated,” he said.
“Folks are going to turn up in truly emerging conditions. They’ve put it off. They’ve waited as long as they can, because ‘I know if I go to the hospital, if I go to an urgent care clinic, I’m going to receive a bill, and I can’t afford to pay for it,’” Jones said.
‘Eye-popping’ increases
The increases in health insurance costs if the tax credit is not extended “are eye-popping,” said Michael Elliott, chief operating officer at VCU Health System.
A hypothetical, 60-year-old Richmond couple earning just under $82,000 a year might face a $904 a month hike in health insurance costs. Two 40-year-olds with two kids would face an increase of $207 a month, according to the calculations of the State Corporation Commission’s Health Benefit Exchange for Affordable Care Act coverage.
Thinking of a hypothetical dad he called Joe, Elliot continued, “Let’s say Joe says … ‘This is not something we can do right now. We’re all in pretty good shape as a family, so we’re going to forgo this and hope that nothing happens.’
“I think we’ve all learned that hope is not a strategy,” he said.
“But Joe’s children are active, and they’re athletes, and things happen at times when you’re athletes. … They end up in the emergency room, and there’s some pretty big bills that come along with that.”
Taking the scenario a bit further, Joe might be in pretty good shape, but at middle age, “we have to do lots of preventative items in order to keep ourselves healthy,” Elliott said.
“Hypertension starts to creep up in prevalence as we get a little older as well. It’s called the silent killer for a reason. You have to stay on top of it, or you won’t feel the effects sometimes until you’ve had an acute cardiac event.”
The much higher cost of treating cancer or a heart attack, as opposed to setting up and analyzing a mammogram or getting a prescription for high blood pressure after a checkup, would push the total cost of health care in Virginia higher, he said. That bigger bill would fall on everyone, since the uninsured likely would be unable to write the kind of six-figure check that would do the job.
“The impacts that occur are not only clinical and real, but they are financial as well,” Elliott said.
Hospitals face big income cuts from Trump’s bill
Virginia hospitals and doctors face big cuts in income under President Donald Trump’s tax-and-budget bill while Virginians with Obamacare coverage could see big premium increases if a Biden-era tax credit goes away, state officials say.
From a business perspective, hospitals are proud to take care of uninsured patients, but “usually don’t collect very much at all” for the services, Elliott said. “That actually raises the prices for others who do have commercial insurance, to help offset some of those costs,” he said.
But it’s more than just the hospital business that’s affected, he said. There are implications for other businesses as well.
Entrepreneurs “are out there saying, ‘Man, I can take a run at starting a new company, and I know I can hire two great tech workers, software designers, AI experts, and get it going, and they can roll in the exchange so they’re getting a benefit,’” Elliott said. “This is a business policy that we’re talking about.”
Small businesses
Ron Carey, founder of Tilt Creative and a director at Chamber RVA, the area’s chamber of commerce, said Richmond, with its vibrant advertising and film sector and growing gig economy sector, might be particularly affected.
“I think this particular issue is very underestimated at this point and could be the tsunami that’s heading toward us, coming on shore if we don’t get in front,” he said.
“Across the state of Virginia, we’ve got about 78,000 small businesses. And think about who does your shoe repair. Think about who does your lawn care. Think about all those services. … Most of those don’t provide health care, right?” he said.
Sticker shock
The issue is about to come to a head, Jones said. Without congressional action, as people start looking at their options for next year’s coverage, prices that used to factor in the tax credit won’t.
Virginians saw premium costs fall in 2023 thanks to an innovative state reinsurance program. The program reimburses health insurers for some of the costs of relatively large claims for payment from the hospitals, physicians and other health care providers treating policyholders.
Rates have remained essentially flat since, and the new rates would be a jolt.
As the open enrollment period approaches, “they’re going to … be faced with what I’ll call the sticker shock,” Jones said. Then they will face a decision.
“Do I reenroll?” he said. “All of a sudden, if we’re in a situation where folks decide to not reenroll, they are still going to get sick.”
Photo credit: erdikocak/iStock
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© 2025 Richmond Times-Dispatch, Va. Visit www.timesdispatch.com. Distributed by Tribune Content Agency LLC.
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