My Infuriating ACA Marketplace Story

By Angie Girard

I turned 62 this month, in the nick of time. On my birthday, Brian and I submitted our application to become registered domestic partners, which among other things, will save me thousands in healthcare insurance premiums and related healthcare expenses.

Long story short, we have been together for over 20 years and have a healthy skepticism of marriage (been-there-done-that, and too many other reasons to enumerate here). When I decided to retire at 59, health insurance was an enormous factor. To be covered as a dependent on Brian’s insurance we had to be married or be registered domestic partners. As noted, marriage was out of the running so we looked at the pros and cons of WA State registered domestic partnership law. One of the requirements, if you’re not a same-sex couple, is that one of you must be 62 years of age. Thus, this birthday = domestic partnership. In the interim, I have had health insurance through the Affordable Care Act (ACA) marketplace.

Most of you know there are devastating changes on the horizon for Medicare and Medicaid, AND the ACA marketplace will be eviscerated.

Almost 1 in 7 US residents had enrolled in a marketplace plan at some point during the first 10 years of its existence. More people than ever before, over 24 million, signed up for marketplace coverage for 2025. These are people under age 65 (because Medicare kicks in at 65) who work for small companies that don’t have employer-based coverage, or they work fewer than 30 hours a week thus don’t qualify for their employer-based plan, or are self-employed, or work a gig job (or jobs), or, or, or . . . The point is, they are income-earning, tax-paying US residents, most of whom would otherwise be without health insurance.

Of those on a marketplace insurance plan, about 92% of us receive a subsidy through premium tax credits and cost-sharing reductions based on our income. Think about this like employer-based insurance premiums; the employer pays a portion, and the employee pays a portion. Most of us don’t pay attention to what our employer pays, nor do those of us on the marketplace pay attention to what the government pays—though we should, because it is a LOT (more on this below). I was unable to find the average marketplace premium for family vs individual, so the average of all enrollees is provided in the right column of the table. Look at the amounts the employers and federal government pay. DAMN!

US Average Monthly Health Insurance Premiums 2024

Sources: https://thatch.com/blog/average-employee-health-insurance-cost-per-month and https://www.cms.gov/files/document/effectuated-enrollment-early-snapshot-2025-and-full-year-2024-average.pdf

The marketplace federal subsidies (like the employer-paid portion) make your premium portion affordable which is why more Americans have health insurance than ever before. Since the ACA’s major coverage provisions were implemented in 2013, the number of people with health insurance coverage has grown by more than 38 million, and the nation’s uninsured rate has nearly halved, falling from 14.4% in 2013 to 7.9% in 2023. Amazing! More people with health insurance coverage, especially healthy people, means lower premiums. Healthy people in the risk pool offsets the higher costs of sicker people (which was one of the core arguments of the ACA). But premiums have instead increased. A LOT. The insurance industry blames requirements on covering pre-existing conditions and more comprehensive benefits as well as general increase in overhead costs for the rise in premiums.

Okay, so let’s give the healthcare insurance industry the benefit of the doubt. They had to raise premiums so everything would be copasetic, stable, proportional, right?

Then explain to me why health insurers had profits of more than $371 billion and health insurers’ stock prices were up 448% (far outpacing the S&P 500) over that same ten-year period. That my friends, is pure greed. The tax credit and subsidies mentioned previously are paid directly to the insurance carrier by the federal government and can be anywhere from $1 to well over $1000 each month, per person. Congress (ALL OF THEM) were asleep at the wheel until the Big Bullshit Bill raised its ugly head.