Health Insurance Struggles for Colusa Family Amid Rising Costs
COLUSA, Calif. — Gene Franklin took some solid career advice to heart early on: “Pay yourself first.” She did just that, and by the time she transitioned to being a stay-at-home mom at 41, she had accumulated a substantial retirement fund.
She and her husband, Charles, known as Chaz, envisioned a comfortable retirement raising their kids in a three-bedroom home located about 90 miles northwest of Sacramento.
However, things took a turn for the worse early last year. At 63, Gene began having difficulties with her balance. One morning in May, she woke up with slurred speech and ended up in the hospital, where she quickly lost mobility on her right side.
While doctors were still trying to determine a diagnosis in August, the couple received alarming news: their health insurance plan would stop covering premiums on January 1st. That meant their monthly payments would skyrocket from $540 to a staggering $3,899. The cause? The federal premium enhancement subsidy was ending, leaving them to bear the full cost.
They swiftly canceled a month-long cruise they had planned with friends and began reviewing their retirement savings.
“Right now, instead of thinking about future retirement plans, we’re focused on whether we can afford health care costs,” Chaz, who retired at 59, noted.
The challenges continued when, in October, Gene received a diagnosis of ALS, a progressive disease that can leave individuals unable to speak or swallow. On the plus side, this diagnosis allowed her to enroll in Medicare, cutting down their insurance premiums by about $1,600 a month. Yet, the relief was bittersweet as she became dependent on others for basic tasks.
“It’s a little morbid that I got on Medicare so soon because I was diagnosed, but at least I don’t have to handle the copay,” Gene admitted from her wheelchair, wrapped in a blanket for warmth. “We’re not going to be buried by this.”
Despite the savings, the financial strain remained significant. The couple anticipated monthly expenses of $2,300, which includes around $342 for Gene’s Medicare supplement insurance—more than their mortgage and taking up over a quarter of their budget.
The Franklins are not alone; around 22 million others nationwide face similar economic pressures after Congress decided not to extend enhanced federal aid from 2021. With that support, enrollment in Affordable Care Act (ACA) plans had surged, showing how crucial those subsidies were.
Looking ahead to 2024, the Congressional Budget Office estimated that without the tax credit extension, 2.2 million more Americans could find themselves uninsured. As of January, enrollment in ACA plans dropped by about 1.2 million compared to the previous year. The ongoing rise in insurance premiums could lead to many defaulting on payments and losing their coverage.
Groups most affected include early retirees and middle-income individuals, particularly those living in pricier states. The Franklins fit all these categories.
“They fell off the so-called subsidy cliff,” commented Stacey Pogue, a senior fellow focused on health care reform. “It’s quite shocking how much burdens people need to absorb.”
This situation has been especially tough for those just above retirement age. Gene and Chaz, for example, have found themselves losing financial aid they previously would have received, with insurance companies responding to the pressure by hiking premium rates sharply.
A study indicated that nearly half of those likely to lose premium tax credits are between 50 and 64 years old, illustrating the abrupt changes many face.
Opponents of the subsidy extension argue funds would go more to insurance companies rather than directly benefiting consumers. They point out that the previous aid didn’t have income restrictions but now seems excessive, especially for higher earners.
“Most Americans would probably agree that taxpayer money shouldn’t subsidize health insurance for people making $250,000,” said U.S. Congressman Ken Calvert, who voted against renewing the aid in January.
Patient advocates warn the rising costs lead people to make difficult decisions. Some healthier individuals are opting out of the system altogether, while others are cutting back on necessary treatments and medications.
The Franklin family leans on their sons to help with expenses like an electric recliner and a handicap-accessible van. Chaz, for instance, has delayed getting a crown for a broken tooth because the cost was too steep at $1,000.
This year, they plan to withdraw $36,000 more than they anticipated from their retirement to cover Chaz’s increased premiums.
“I’ve got a nest egg,” Chaz said, “but I know many people don’t have that safety net.”
Initially, Chaz felt quite angry about their circumstances.
“I hope Congress can come together to solve this issue,” he remarked, expressing a mix of disappointment at both parties. “It’s frustrating to see them squabbling over trivial matters while real issues go unresolved. Where was all this debate two years ago?”
Chaz’s main priority now is to ensure Jean, his wife of 27 years, is as comfortable as she can be. They used to share many activities, including hiking, traveling, tai chi, and even amateur photography—Gene had a fondness for collecting insects, one of which was a unique scarab-like beetle.
Every morning, Chaz and their sons, Charlie and Louis, take turns getting Gene dressed and assisting her with daily needs. She often lightheartedly remarks that her sons’ experiences will surely require some therapy down the line.
Most days, Gene’s foray into the outdoors consists of being wheeled out to enjoy watching their backyard chickens. Chaz’s determination makes him an excellent advocate for her care, while Charlie often knows just when she needs a comforting hug, and Louis never fails to make her laugh.
“I don’t know what I would do without making my boys laugh,” Gene said.
Chaz will be turning 65 soon, making him eligible for Medicare as well. “Once this year wraps up, we should be okay,” Jean remarked, sharing a knowing smile with her husband. “Well, at least we hope so.”
