随着联邦政府关门进入第三周，一些美国人担心患者保护与平价医疗法案(ACA)补贴的未来。
补贴或保费税收抵免有助于降低或消除那些通过健康保险市场购买保险的人每月保费的自付费用。
它们在新冠肺炎疫情期间得到加强，目前将于2025年底到期。
民主党人一直要求共和党人在政府重新开放之前通过延长补贴，而共和党人表示，在清洁资金法案通过和政府重新开放之前，他们不会谈判。
最近的一次来自KFF的分析发现如果ACA增强的保费税收抵免到期，保费支付可能在2026年增加一倍以上。
一些依靠税收抵免来帮助支付他们或他们家人的部分或全部保费的美国人告诉ABC新闻，他们担心如果补贴到期，他们可能被迫选择一个不太全面的保险计划，或者他们可能无法支付他们的保费。
我们“不能没有保险”
来自伊利诺伊州埃格林的67岁的道格·布查特(Doug Butchart)告诉美国广播公司(ABC)新闻，他的妻子沙德妮患有肌萎缩性脊髓侧索硬化症(ALS)，目前通过健康保险市场获得保险。
58岁的Shadene Butchart开始时参加的是蓝十字青铜计划，也就是最低级别的计划，但是随着疾病的发展，这对夫妇决定升级到最高级别的黄金计划，该计划可以支付她更高比例的医疗费用。
该计划的保费为每月1，273.82加元。Butcharts获得了增强的保费税收抵免，涵盖每月670美元的保费，使他们每月自己支付603.82美元。
道格·布查特说，如果没有保险费税收抵免，他们就无法负担每月的全部保险费。
“我听说(保费可能会上涨)25%至50%，”他说。“这是不可持续的，因为我们负担不起，但也不能没有保险。”
道格·布查特说，他的妻子不符合医疗保险资格，他们也没有达到享受医疗补助的收入门槛。
他解释说:“我们就像被夹在中间一样，因为通常诊断出ALS，你就自动有资格享受[社会保障残疾保险]和医疗保险，但她没有任何工作信用，所以她没有资格享受社会保障残疾保险。”“所以现在，我们正在尽我的社会保障，很难支付所有的账单和保持保险，如果他们扰乱市场保险，这将使我们不可能负担得起保险。”
现在Butchart已经达到了今年的免赔额，再加上预计可能会失去税收抵免和参加较低层次的保险计划，这对夫妇正试图利用保险来获得Shadene Butchart在年底前管理ALS所需的尽可能多的设备。
道格·布查特说，这包括一份新轮椅的订单，沙丹·布查特可以用她的眼睛驾驶轮椅，价格可能在65，000美元到95，000美元之间。
道格·布查特说，他们明年可能不得不降级到较低等级的计划，但他不确定他妻子目前服用的药物是否会被“较低等级的计划”覆盖
道格·布查特是一名退休机械师，他说他感到很幸运，因为他不需要担心房子或汽车的付款——这两项都已还清——但还有其他账单要付，他没想到每个月都要为支付保险费用而挣扎。
“你一生都在工作，让自己过得舒适，我相信有些东西我们可以不要，但没有那么多疯狂的支出来支付每月1500美元的保险，”他说。“那可是一大笔钱。...直到你需要保险的时候，你才意识到保险有多重要。”
“这非常令人担忧”
南希·墨菲是一名退休的注册护士和保险业雇员，她今年首次能够通过ACA获得佛罗里达蓝保险。
她告诉ABC新闻，每个月她的保费是1019美元，增加的保费税收抵免涵盖了总成本。如果在11月1日开放注册截止日期前没有达成协议，或者税收抵免在年底到期，她担心是否能够支付这笔费用。
“这很令人担心。60岁的墨菲住在劳德代尔堡，她说:“如果税收抵免到期，我肯定负担不起。"作为一名1型糖尿病患者，这是一个可怕的想法."
墨菲说，她使用胰岛素泵来控制她的糖尿病，这是她的保险范围内，没有共付额。然而，她说她有时会使用每月共付额为30美元的其他药物。
她补充说，失去税收抵免是一个问题，因为她有其他成本，她想确保她可以管理，包括财产税和她女儿在波士顿的大学学费。
在不知道保费将增加多少的情况下，她说她非常担心自己的预算会是什么样子。
“我就像在地狱边缘，这种感觉真的很不舒服，”墨菲说。“我喜欢做预算，并计划好自己的预算。由于学费、财产税和房子周围需要进行的维修，我需要把这些都规划出来。”
她继续说，“这些事情对我来说是如此令人心烦意乱。我们是美国公民。我们应该能够获得我们的税收来满足我们的医疗保健需求。”
Some Americans fear high health insurance premiums if ACA enhanced subsidies expire: 'Very much a worry'
As the federal government shutdown enters its third week, some Americans are worried about the future of the Affordable Care Act (ACA) subsidies.
The subsidies, or premium tax credits, help lower or eliminate the out-of-pocket cost of monthly premiums for those who purchase insurance through the health insurance marketplace.
They were enhanced during the COVID-19 pandemic and are currently set to expire at the end of 2025.
Democrats have been demanding that Republicans pass extensions of the subsidies before the government is reopened, while the GOP says it won't negotiate until a clean funding bill passes and the government reopens.
A recentanalysis from KFFfound that premium payments could more than double in 2026 if the ACA enhanced premium tax credits expire.
Some Americans who rely on the tax credits to help pay for some or all of their or their family's premiums told ABC News they're worried that if the subsidies expire, they may be forced to choose a less comprehensive insurance plan or they may not be able to cover the cost of their premiums.
We 'can't afford to not have insurance'
Doug Butchart, 67, from Eglin, Illinois, told ABC News that his wife, Shadene, has amyotrophic lateral sclerosis (ALS), and currently receives her insurance through the health insurance marketplace.
Shadene Butchart, 58, started off on a Blue Cross bronze plan -- or the lowest tier -- but, as her disease progressed, the couple decided to upgrade to a gold plan, the highest tier, which covers a higher percentage of her health care costs.
The premium under this plan is $1,273.82 per month. The Butcharts receive enhanced premium tax credits that cover $670 of the monthly premium, leaving them to pay $603.82 per month themselves.
Without the premium tax credits, Doug Butchart said they cannot afford to pay the entire premium out of pocket each month.
"I've heard [premiums could rise] anywhere from 25 to 50%," he said. "And that's not sustainable because we can't afford that but can't afford to not have insurance."
Doug Butchart said his wife doesn't quality for Medicare and they don't meet the income threshold to qualify for Medicaid.
"We're stuck like in the middle because, normally with an ALS diagnosis, you're automatically eligible for [Social Security Disability Insurance] and Medicare, but she doesn't have any work credits, so she doesn't qualify for Social Security Disability," he explained. "So right now, we're doing everything off of my Social Security, and it's very hard to try and pay all the bills and keep insurance and, if they mess around with the marketplace insurance, it's going to make it impossible for us to afford insurance."
Now that the Butcharts have met the deductible for the year, combined with the anticipation of possibly losing tax credits and going to a lower tier insurance plan, the couple is trying to use insurance to get as much equipment as Shadene Butchart needs to manage her ALS before the end of the year.
This includes an order for a new wheelchair that Shadene Butchart could drive with her eyes, and that could cost anywhere from $65,000 to $95,000, Doug Butchart said.
Doug Butchart said they may have to downgrade to a lower-tier plan next year, but he's not sure if the medications his wife currently takes will be covered by a "lesser plan."
Doug Butchart, who is a retired mechanic, said he feels lucky that he does not need to worry about house or car payments -- both of which are paid off -- but there are other bills to pay and he did not expect to have to struggle to meet insurance costs every month.
"You work your entire life to make yourself comfortable and I'm sure there are things that we could do without but there's not that much crazy spending to possibly have to cover $1,500 a month for insurance," he said. "That's a lot of money. ... You don't realize how important insurance is until you need it."
'It's very much a worry'
Nancy Murphy, a retired registered nurse and insurance industry employee, was able to receive insurance through the ACA for the first time this year with Florida Blue.
Every month, her premium is $1,019 and the enhanced premium tax credits cover the total cost, she told ABC News. If there is no deal made before the Nov. 1 open enrollment deadline or the tax credits expire at the end of the year, she's concerned about being able to cover the cost.
"It's very much a worry. I definitely could not afford that if the tax credits expire," said Murphy, 60, who lives in Fort Lauderdale. "It's a scary thought as a type 1 diabetic."
Murphy said she uses an insulin pump to manage her diabetes, which is covered by her insurance without a co-pay. However, she said she sometimes uses other medications that have a $30 a month co-pay.
She added that losing the tax credits is a concern because she has other costs she wants to make sure she can manage including property taxes and her daughter's tuition for college in Boston.
Without knowing exactly how much premiums are going to increase by, she said she's very anxious about what her budget will look like.
"I'm like in limbo and it's a really uncomfortable feeling," Murphy said. "I like to budget and plan out my budget. With tuition, property taxes and repairs that need to be done around the house, I need to map these out."
She continued, "These things to me are so upsetting. We are American citizens. We should be able to access our tax dollars for our heath care needs."
