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Why are health care costs the linchpin between Democrats and Republicans in the federal budget shutdown?
At issue is whether Congress will extend enhanced tax credits that help consumers pay for insurance plans on the Affordable Care Act marketplaces. The credits are set to expire at the end of this year. If they're not extended, premiums are expected to double for many consumers next year, as NPR's Selena Simmons-Duffin reports.
About 24 million Americans purchase insurance on state or federal marketplaces set up under the Affordable Care Act (Obamacare). These are people who are self-employed, run small businesses, or work at employers that don't offer health insurance. A few years ago, the federal government changed the structure of the tax credits, which amounted to bigger subsidies for many. The Congressional Budget Office estimates that about 4 million people will lose insurance over the next four years if the enhanced subsidies are allowed to expire.
Here are five key facts about the policy debate.
1. The subsidies have a lot of public support.
A KFF poll last week found that more than three-quarters of people across the political spectrum are in favor of Congress extending the enhanced ACA tax credits. Other polls have had similar findings.
2. Time is of the essence, since open enrollment starts soon
Democratic lawmakers want to see the enhanced subsidies extended before enrollment begins Nov. 1, and they have made that a condition of voting to reopen the government.
During open enrollment on the ACA exchanges, consumers will be able to renew their current plan for next year or shop for a new one. If Congress misses that deadline, people who log in to shop for a plan will see much higher premiums. Even if Congress ultimately extends the credits by the end of December, there’s a fear that sticker shock in November could lead to people opting to go without insurance for 2026.
3. If the enhanced subsidies expire, it would compound already increasing healthcare costs
Health insurance costs are rising across the board, not just for ACA plans. "On average, we're expecting premium payments by enrollees to increase by 114% if these enhanced tax credits expire," says Cynthia Cox, director of the Program on the ACA at KFF.
4. Most people affected live in states that Trump won
More than 3 in 4 Obamacare enrollees live in states that President Trump won in 2024, according to KFF. Some Southern states have seen dramatic growth in enrollment in the last few years.
5. The subsidies are expensive for the government
The Congressional Budget Office estimates it would cost the government $350 billion over the next decade if the enhanced subsidies were extended permanently. In a letter to the President, a coalition of groups argued that extending the subsidies would incentivize insurers to keep raising prices, and contribute to higher costs for everyone in the long run.
Learn more about the healthcare cost showdown behind the shutdown.
Do you have subsidized health insurance through your state, or the federal exchange? How have health care tax credits impacted your life? Share your experience at health@npr.org, and we may share your comment in a future newsletter.
Also: Health insurance premiums are going up next year — unless you work at one of these companies
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Ever wish you could still call Ray from Car Talk? Now you can.
Starting this month, as a new bonus feature on Car Talk+, members will get to hear the younger Tappet Brother yuck it up with listeners again on a semi-quasi-regularish basis. “Whenever I can fit it in between my yoga classes, Mahjong games, and mechanics’ romance book club meetings,” says Ray.
The best part of joining Car Talk+, aside from supporting public media? You can ask Ray a car question yourself by leaving him a message at 888-522-5478. If he picks your question, he’ll take your call and chat with you about your expiring Explorer or limping Lamborghini.
In other bonus episodes for Car Talk+, you’ll hear producer’s picks of some of the best moments from the series, highlights of Tom’s mail segments, and prehistoric excerpts from Weekend Edition, aired on NPR before Car Talk was even launched. And supporting Car Talk+ means you’ll also get archive access to 800+ OG Car Talk episodes.
Join Car Talk+ and join us in welcoming back Ray! |
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Juliana Belo Gutierrez/iStockphoto/Getty Images |
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Social media is a powerful force. Just now scrolling on TikTok, I came across a video compilation of dogs saving young children from increasingly alarming threats, from a falling TV to an attacking mountain lion. I was so moved, I felt the urge to show my friends …until I remembered how commonplace such videos have become on the internet. And I’m not going to share the link here, because you’d stop reading the newsletter and immerse yourself in a little world of canine heroics.
With so much appealing content sucking up our attention, it’s no wonder that traditional measures of performance appear to be suffering. NPR’s Rhitu Chatterjee reported on a new study showing that preteens using increasing amounts of social media perform poorer in reading, vocabulary and memory tests compared with those who use no or little social media.
Researchers analyzed a data set collected from thousands of preteens. Kids are surveyed about their social media use every year, and take a range of tests for learning and memory every other year. This study looked at three groups of data: a high-use group that was spending three or more hours a day on social media, a medium use group who spent about an hour a day on social platforms, and a group that used little or no social media (preteens without social media? Who knew!)
The group that used social media the most performed up to 4 to 5 points lower than the non-social media users on the tests. The group that used social media about 1 hour a day performed 1 to 2 points lower on the reading and memory tasks compared to adolescents who did not use social media.
"That really speaks to the dosage effect of these [apps]," says psychologist Sheri Madigan at the University of Calgary, who wrote an accompanying editorial for the study. "It's problematic at really high uses, but it's also problematic at even in small doses."
Adolescence is a critical period for brain development, and social media is changing the way young brains develop, says Mitch Prinstein, a psychologist who wasn’t involved in the new research.
In a recent study, Prinstein and his colleagues found that teens who are heavy social media users have brains that are more attuned to the kind of rapid, constant feedback available on social media. “Kids become hypersensitive to the kinds of likes, comments, feedback and rewards they might get from peers," Prinstein says.
"It makes perfect sense that if their brain is growing to be optimized for social media activities, it might not be optimized for other things they need to do,” he adds.
Read more about the research, and how it might influence phone and social media restrictions at schools.
Plus: More students head back to class without one crucial thing: their phones |
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Charles Paajoe Tetteh for NPR |
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Study: We're losing the war against drug-resistant infections faster than we thought |
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We hope you enjoyed these stories. Find more of NPR's health journalism online.
All the best,
Andrea Muraskin and your NPR Health editors |
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