RESOURCES:
Washtenaw Health Project on Facebook
Washtenaw Health Project on Instagram
Washtenaw Health Project on LinkedIn
TRANSCRIPTION:
Caroline MacGregor: This is 89.1 WEMU. I'm Caroline MacGregor. And today, we are discussing health insurance and the difficulty for many in affording it. With me today to talk about a noted decline in health insurance enrollment is Jeremy Lapedis. He is the Executive Director of the Washtenaw Health Project. They are a non-profit organization that connects Washtenaw County residents with affordable health care and coverage, regardless of their income or immigration status. Welcome, Jeremy! Thank you for joining us today!
Jeremy Lapedis: Yeah, thank you so much for having me!
Caroline MacGregor: Now, your team at the Washtenaw Health Project, you support Washtenaw County residents who do not have health insurance, in addition to those who've questions or concerns about their current plan or even changing life circumstances. Your organization has reported a sharp decline during the 2026 Health Insurance Marketplace open enrollment period. Tell me what this is reflecting for the community at large with respect to affordability challenges for local families.
Jeremy Lapedis: Yeah. So, the Marketplace, or Obamacare, open enrollment period every year goes from November to January. And this year, the Washtenaw Health Project saw a significant decline in the number of people we enrolled in health care coverage. A lot of the reason for that decline was simply that the prices for the health insurance premiums more than doubled for many people. The reason for this is, well, one, health insurance premiums have gone up across the board, and that's not just true for the marketplace. But the largest reason for this is the expiration of the enhanced subsidies that cause premiums to rise.
Caroline MacGregor: And I know that many families have been basically waiting for Congress to lower health care costs, but many had to walk away because that didn't occur. Tell me about the disparity in numbers of those who applied for help in 2025 versus 2026, if you would.
Jeremy Lapedis: Yeah. And so, this is just for our organization. You know, we only were able to enroll about 550 people in marketplace coverage in 2026, down from around 800 enrollees in the previous year, which is a 30% decrease. Now, if you look at numbers across the state, the preliminary numbers show about a 6% to 7% decrease from the previous year. Though, I expect that number to grow as the year goes on and people lose their coverage after not having made these payments for these higher premiums.
Caroline MacGregor: So, it's safe to say, as you indicated, that the decline appears to be following the Affordable Care Act, which provided premium tax credits, helping reduce insurance costs for families. Now that this has changed, where are families turning to for help if they have dire circumstances and need insurance?
Jeremy Lapedis: Yeah. And so, this is really a challenge for folks. We had some people actually that are signing up for health care coverage, going to pay their premium for January, go to get a checkup, and if they're healthy, they're going to cancel their coverage because they're not able to afford it. But if they didn't sign up to begin with, folks can turn to federally qualified health centers, which will have sliding scale payments available for folks who do not have health insurance. Also, your public health departments have give free immunizations or lower cost immunizations if you don't have health insurance. And then, there are also health systems that offer financial assistance programs and some prescription assistance programs for folks that don't health insurance.
Caroline MacGregor: How much on average did insurance premiums increase for the average person that you've been talking to?
Jeremy Lapedis: Yeah. So, we are still waiting on hard data for that, but estimates are they went up more than double by maybe 130%. That might look like if your average premium was $130 per month last year, your premium this year might be around $280 per month.
Caroline MacGregor: Okay. And as you've kind of indicated this decline, you stated that it reflects a disproportionate impact of subsidy changes on lower-income populations and also immigrant communities in Washtenaw County.
Jeremy Lapedis: Yeah. So, in 2025, there were 15,000 people who were on the Marketplace. About half of those people were people making under 200% of federal poverty level. And just to give you an idea, that's about $31,000 for a single person. So, about half of people are making less than $31,000 a year. And those are the folks who were getting the largest subsidies from the enhanced Affordable Care Act subsidies. Those expired. And so, their premiums went up more than folks who we're getting lower subsidies in previous years. And they had to make the harder choices of, "Well, am I going to be able to pay my rent, put food on the table, or have health insurance?"
Caroline MacGregor: I know that this has been one of the issues that Congresswoman Debbie Dingell has been raising quite a bit about the choices that people are being forced to make.
Jeremy Lapedis: Certainly. You know, we're expecting folks, one, many people are automatically enrolled in health care coverage, and so we're expecting them not to make that payment and to see cancelations rates. But even folks who are enrolled in coverage and purposely enrolled, we expect to see greater cancelation rates simply because they can't afford it.
Caroline MacGregor: You've touched on it a little bit, but a bit more about, say, what the average couple is experiencing as far as actual increased costs. I mean, you talked about more than double. Was it 130% increase?
Jeremy Lapedis: Yeah, thereabouts. Yeah. And the way you calculate it is complicated based on age and family size and income. So, it's difficult to say without a little bit better data, which we don't have yet. But people used to be able to get a silver premium plan for relatively low cost. I think the average for folks who got a premium half-credit last year was about $130. And now, they're not able to get that silver plan. And so, instead, they're looking at bronze plans, which have much higher deductibles. And so, even if the premium is maybe similar to what they were paying last year, they have thousands of dollars of out-of-pocket costs they need to pay before the health insurance will kick in. And so, they're looking at it and saying, 'This doesn't seem like it's worth it for me."
Caroline MacGregor: You know, here in the U.S., it's a fairly complex issue. As health care costs continue to rise each year, there appears to be a common misconception that it's just health insurers setting the prices for care and prescriptions. But in reality, it is the health care providers, the hospitals, the doctors, the pharmaceutical companies who decide what to charge for the care and the medications that they provide. Why are they allowed to get away with charging so much?
Jeremy Lapedis: Well, okay, this is a really complicated question. I'll say this. For now, when there are fewer people with health insurance, that is going to raise costs for everybody because folks who had preventable conditions, maybe asthma, maybe diabetes or heart disease, they could take a medication in a preventative way to prevent hospitalizations if you're diabetic to prevent kidney failure. Whereas, if they're not getting that proactively, then they're more likely to go to the emergency room and more likely to have more expensive care. And if they don't have insurance, the health systems are going to need to pay for that care themselves. And then, they are going to turn around and charge us--everybody who does have insurance for that. And so, a part of this is this negative spiral we have, which is the more uninsured folks we have, the greater the cost to the overall system. And that is every single person who receives health care in this country.
Caroline MacGregor: I know that insurance companies negotiate to the best of their ability with care providers to bring the rates down for the average person, but what can be done?
Jeremy Lapedis: What is different in this country is that we have about 70% of people, at least in Washtenaw County, are covered by employer-sponsored coverage. And so, we have this system where insurance companies are negotiating on behalf of employers who are actually the ones who are footing the bill.
Caroline MacGregor: But the lowdown here is that the person without means, families, people who do need help. Not all of us have employers or people who are helping to pay for our insurance. Life is tough for many people. I mean, obviously, you are helping guide people to the best of your ability, but what are you telling people with low incomes where to look? You talked about turning toward the federal insurance.
Jeremy Lapedis: Yeah. So, if folks do not have insurance, we are encouraging everyone to get insurance. We still think it's a good thing to have. Signing up for a bronze plan can be really protective in case you have an emergency. A lot of hospital financial assistance policies require you to have insurance in order to use them. And so, coupling a insurance policy with a high deductible plan with a hospital financial systems policy can be a good way to go for some people. If you don't have insurance, the federally-qualified health centers will provide excellent care. And I would encourage folks. There is help out there, so please do reach out. If you're in southeast Michigan, you can reach out to the Washtenaw Health Project at 734-544-3030, or you can email us at whp@washtenaw.org. But I encourage you to go to your local public health department. That's what they're there for. They will try to help you figure out something to do. This is a challenging time. You know, it used to be, last year, it was great. We could give people an option, and they could relatively afford it, and it would be good coverage. And this open enrollment time, we had to help people weigh the best amongst bad options. So, I'd say it just wasn't a fun open enrollment season. I am hopeful that we'll be able to come up with solution locally in Washtenaw County. I'm in conversations with our major health systems and our county government to see is there something we could come up with locally to help with this. And I think I want to see if there's something we can do across the state to think about how can we address this. And so, I am encouraged that I think there are things that we can do locally to mitigate this, though it is certainly a challenging time.
Caroline MacGregor: My guest today has been Jeremy Lapedis. He's the Executive Director of the Washtenaw Health Project, a non-profit organization that connects Washtenaw County residents with affordable health care coverage. Thank you, Jeremy, for joining us today!
Jeremy Lapedis: Thanks so much for having me!
Caroline MacGregor: This is 89.1 WEMU-FM Ypsilanti.
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