\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on “All Things Considered,” Marketplace, the BBC, 99% Invisible, and “Reveal” from the Center for Investigative Reporting.\t\t<\/p>\n
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\tEmily Pisacreta
\n\tProducer<\/p>\n
\tClaire Davenport
\n\tProducer<\/p>\n
\tAdam Raymonda
\n\tAudio wizard<\/p>\n
\tEllen Weiss
\n\tEditor<\/p>\n
\t\t\t\t\tClick to open the Transcript\t\t\t\t<\/p>\n
\t\t\t\t\t\tTranscript<\/strong>: \u2018Not workable\u2019: How two Americans picked a plan this year \u2014 or didn\u2019t<\/strong>\t\t\t\t<\/p>\nNote: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\nDan:<\/strong>\u00a0Hey there. About a dozen years ago, Nicole Wipp was trying to spend less time running her law firm and more time with her son, who was in preschool. ?It was a work in progress.\u00a0<\/p>\nAnd then she started feeling\u2014 a little off. ?Tired. Out of breath. Her doctor thought it was stress.<\/p>\n
Nicole didn\u2019t think so, but she soldiered on. And got worse. For months. Until one day\u2014 when she told her husband she just couldn\u2019t get off the couch \u2014 he was like, you\u2019re going to urgent care. An x-ray showed her whole left lung totally blacked out.?<\/p>\n
\u00a0Next stop, emergency room.\u00a0<\/p>\n
Nicole Wipp:<\/strong>\u00a0They put a huge needle and shoved it into my back and drew out two liters. Imagine a whole two-liter of pop \u2013 I\u2019m from Michigan, so I say pop \u2013 from your body. They draw a whole two-liter of liquid. And I felt so much better immediately. I was like, wow, I can breathe. Like, wow, this is so cool. But, um, it was sort of horrifying.<\/strong><\/p>\nDan:<\/strong>\u00a0Nicole says she eventually got diagnosed with a rare lung condition<\/p>\nNicole Wipp:<\/strong>\u00a0It\u2019s called lymphangioleiomyomatosis \u2014 LAMB for short.<\/strong><\/p>\nDan:<\/strong>\u00a0But not before she\u2019d spent a month in hospitals \u2014 hospitals, plural \u2014 and had multiple expensive surgeries.<\/p>\nNicole Wipp:<\/strong>\u00a0Minimum \u2014 my husband and I tried to like tally it all up, like look at all the bills afterward \u2014 and it was, minimum, a half a million dollars.\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0Which, because her husband\u2019s job at the time provided good health insurance, didn\u2019t break them.<\/p>\nNicole\u2019s condition hasn\u2019t bothered her for years. But it\u2019s not cured. It\u2019s incurable.<\/p>\n
And yet. This year, Nicole and her husband didn\u2019t sign up for health insurance.<\/p>\n
For more than 20 million people on Obamacare plans, the price of health insurance changed dramatically this year. Premiums skyrocketed just as subsidies got sharply reduced.\u00a0<\/p>\n
Some people faced horrifically stark new circumstances:\u00a0<\/p>\n
People who needed insurance to cover ongoing treatment: for cancer, for diabetes \u2014 treatment they literally could not live without \u2014 saw premiums jump by thousands of dollars a month, more than they could possibly afford.<\/p>\n
And millions more got stuck taking gambles. Making messy, unsatisfying choices.\u00a0<\/p>\n
Our partners at KFF Health News have been talking with lots of those people.\u00a0<\/p>\n
They introduced us to Nicole. She and her husband could have paid for health insurance. But when rates went up, they did the math and decided not to. They\u2019re generally healthy, and honestly have more financial cushion than most people.\u00a0<\/p>\n
If they need medical care \u2014 ordinary medical care, anyway\u2014 they think they\u2019ll be better off just paying cash.\u00a0<\/p>\n
But they know they\u2019re gambling: that 2026 won\u2019t be the year Nicole\u2019s condition flares up, or that some other catastrophe hits.<\/p>\n
Our pals at KFF Health News also introduced us to this man:<\/p>\n
Noah Hulsman:<\/strong>\u00a0My name\u2019s Noah Hulsman. I own and operate Home Skateboard Shop here in Louisville, Kentucky.<\/strong><\/p>\nDan:<\/strong>\u00a0It\u2019s Louisville\u2019s only skateboard shop. It\u2019s kind of a family business, kind of a community center, kind of a place Noah\u2019s spent most of his 37 years.\u00a0<\/p>\nNoah\u2019s still paying for insurance \u2014 paying for\u00a0 protection against catastrophe. But because all he can afford this year is a bare-bones plan, he doesn\u2019t have a way to pay for ordinary medical care. Which he could actually really use.\u00a0<\/p>\n
Noah Hulsman:<\/strong>\u00a0So I\u2019m kind of in a position right now\u2026 I need my left shoulder looked at, but I have an $8,400 deductible. Yeah.<\/strong><\/p>\nDan:<\/strong>\u00a0 We\u2019ll get into that \u2014 it sucks. But first: I really want you to hear about this skateboard shop.<\/p>\nNoah Hulsman:<\/strong>\u00a0When I tell the story, it almost seems like a movie or something. Like, somebody made this up.<\/strong><\/p>\nDan:<\/strong>\u00a0Let\u2019s go.\u00a0<\/p>\nThis is An Arm and a Leg \u2014 a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann. I\u2019m a reporter, and I like a challenge. So the job we\u2019ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life, and bring you a show that\u2019s entertaining, empowering, and useful.<\/p>\n
Here\u2019s how Noah ended up a skater for life.<\/p>\n
Noah Hulsman:<\/strong>\u00a0So my grandmother, she opened up a skateboard shop in 1988 here in Louisville. It was called Skateboards Unlimited. She had a little skate park also behind it called Ottoman Skate Park.<\/strong><\/p>\nDan:<\/strong>\u00a0Noah\u2019s grandmother was not a skater. She\u2019d been a nurse \u2014 but she had five kids, and Noah says she ended up more of a stay-at-home mom.<\/p>\nNoah Hulsman:<\/strong>\u00a0And then with all the commotion that was always occurring, with all the friends in and outta the house, with having five kids and all these skateboarders that just started popping up, she just decided, you know what? Let\u2019s like have a place for you all to go.<\/strong><\/p>\nDan:<\/strong>\u00a0She opened Skateboards Unlimited \u2014 and a skate park behind it.<\/p>\nWhen her youngest son finished high school \u2014 and moved to the West Coast as a professional skateboarder \u2014 it was the end of an era. And the beginning of another.\u00a0<\/p>\n
Noah\u2019s grandma closed up Skateboards Unlimited.\u00a0<\/p>\n
Noah Hulsman:<\/strong>\u00a0And uh, that\u2019s when one of her employees was like, you know what? We gotta keep having a skate shop.\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0They called it Home Skate Shop. Noah became a regular customer, eventually an employee. And \u2014 ten years ago, when he was 27, \u2014 he took over the business.\u00a0<\/p>\nNoah is as invested as anybody could possibly be.<\/p>\n
Noah Hulsman:<\/strong>\u00a0It\u2019s everything. It\u2019s my whole life. Yeah.<\/strong><\/p>\nDan:<\/strong>\u00a0It\u2019s doing OK. There were a few rocky years early on \u2014 Noah says he qualified for Medicaid. But things actually picked up when the pandemic started.<\/p>\nNoah Hulsman:<\/strong>\u00a0Skateboarding was one of the only things that you do by yourself. You\u2019re doing it outside. If I would\u2019ve been able to get a hold of more product, we would\u2019ve, we would\u2019ve killed it.<\/strong><\/p>\nDan:<\/strong>\u00a0Noah got an Obamacare plan, and he even bought a building \u2014 he leases out a couple of apartments, runs an air bnb in a third one, and says he breaks even on it, right now..<\/p>\nNoah Hulsman:<\/strong>\u00a0They say, you know, real estate is a long term game.<\/strong><\/p>\nDan:<\/strong>\u00a0Noah\u2019s a long-term kind of guy.<\/p>\n\\He and his girlfriend have been together for 16 years \u2014 even while she was away at veterinary school.<\/p>\n
Noah Hulsman:<\/strong>\u00a0She just finished up at Auburn this past year and moved back home and yeah, it\u2019s been awesome.<\/strong><\/p>\nDan:<\/strong>\u00a0Now they live together \u2014 with their four cats \u2014 in an apartment less than a mile from where his grandma started her skate shop.<\/p>\nBut it\u2019s not a cushy living. Noah says he takes odd jobs and gives skateboarding lessons to make ends meet.<\/p>\n
Noah Hulsman:<\/strong>\u00a0Every single day is a hustle. There is no day, like you can\u2019t get sick, you can\u2019t be\u2013\u00a0 no downtime. If you take vacations, you\u2019re still working from your phone, you\u2019re checking in on the shop.<\/strong><\/p>\nDan:<\/strong>\u00a0Noah says his income \u2014 all in \u2014 has been holding steady at around $33,000 a year. Last year, with a subsidy, he was able to get a gold plan for about a hundred and five dollars a month.<\/p>\nFor 2026 \u2014 with premiums jacked up and subsidies cranked down \u2014 that gold plan would have cost him an extra $500 a month. That\u2019s $6000 a year. Way more than he could afford.<\/p>\n
Instead, he picked a Bronze plan. It leaves him paying pretty much exactly the same every month as he did last year, but it covers so much less.<\/p>\n
Noah Hulsman:<\/strong>\u00a0I don\u2019t even know why I\u2019m paying that. It\u2019s useless really, unless I get into a car accident and I have $10,000 worth of bills.<\/strong><\/p>\nDan:<\/strong>\u00a0Or a skateboarding accident. Or a serious illness. Anything.<\/p>\nHe\u2019s holding onto the plan as a backstop against a worst-case scenario, against ending up with more debt than he could ever pay back.<\/p>\n
But having a backstop is not the same as having access to medical care.<\/p>\n
A few months ago, Noah says his left shoulder started bothering him. He says it doesn\u2019t stop him from day-to-day stuff, running the shop. But it does impose limits.\u00a0<\/p>\n
Noah Hulsman:<\/strong>\u00a0It\u2019s those like quick movements. It\u2019s those like blast-off times like when I\u2019m popping on my skateboard or when I\u2019m like turning a certain like front side and like throwing all my weight that way.\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0His bronze plan \u2014 with its $8400 deductible \u2014 means he can\u2019t afford to get it checked out.<\/p>\nNoah Hulsman:<\/strong>\u00a0To go through, okay first you have to go see primary care, then they gotta do the x-ray. Then once you see the x-ray, oh, we can\u2019t tell anything from the x-ray. Yeah, we know because it\u2019s ligaments and tendons and muscles and things like, I\u2019m not a doctor, but I\u2019ve been through this a few times. So, okay, we\u2019re gonna get you the MRI. All right. Here\u2019s the MRI. None of that\u2019s gonna be covered.<\/strong><\/p>\nDan:<\/strong>\u00a0It sounds like thousands of dollars to Noah \u2014 to me too, really. And that\u2019s before getting it treated, which could mean surgery.<\/p>\nNoah doesn\u2019t have thousands of dollars lying around. If he did, he would\u2019ve paid up for the gold plan.\u00a0<\/p>\n
So he\u2019s avoiding tricks that could irritate the shoulder,<\/p>\n
Noah Hulsman:<\/strong>\u00a0 I can still skateboard. I just have to choose what tricks or what obstacles. I don\u2019t have like the freedom that I had when I used to ride my skateboard.<\/strong><\/p>\nDan: He\u2019s hoping he can nurse the injury along till next year, when he thinks he could afford better insurance.\u00a0<\/p>\n
Noah Hulsman:<\/strong>\u00a0What I\u2019m kind of planning on doing is my, my shop vehicle is about to be paid off next year or like at, at the, I think it\u2019s like middle of next year. And that payment is basically what that gold plan payment is.<\/strong><\/p>\nDan:<\/strong>\u00a0Yeah, yeah,<\/p>\nNoah Hulsman:<\/strong>\u00a0That\u2019s what\u2019s probably gonna happen. That\u2019s my new car payment. New shoulder payment.<\/strong><\/p>\nDan:<\/strong>\u00a0Man, that super sucks. I mean, grimly hilarious\u00a0<\/strong><\/p>\nNoah Hulsman:<\/strong>\u00a0Yeah. Yeah. I mean, if this, you have to just laugh at how ridiculous the world is these days. There\u2019s, I mean, if you just take it serious, doom and gloom all the time, it\u2019s going to, you\u2019re not gonna make it. You gotta just laugh these days. It\u2019s so ridiculous.<\/strong><\/p>\nDan:<\/strong>\u00a0It is. Noah is far from alone. A Gallup poll taken in late 2025 found that more than a quarter of all Americans had postponed surgery or medical treatment because of cost.<\/p>\nBeing insured and having access to medical care \u2014 for lots of people, they haven\u2019t been the same for a long time.<\/p>\n
This year, especially for people using Obamacare, that\u2019s accelerating.\u00a0<\/p>\n
We don\u2019t know yet how many people made choices like Noah\u2019s, and moved to plans that cover less, in order to have a monthly payment they could kind of afford.<\/p>\n
Federal numbers won\u2019t be out for a while. But an analyst named Charles Gaba ran some preliminary numbers from a few states.<\/p>\n
He found that the number of people in Silver and Gold and Platinum plans was down significantly. And the number of people in Bronze plans, the cheapest, was up dramatically.<\/p>\n
And we do know that at least a million people have dropped Obamacare. Some have dropped insurance altogether. Including, of course, Nicole Wipp.<\/p>\n
We\u2019re coming back to her story, just ahead.\u00a0<\/p>\n
This episode of An Arm and a Leg is produced in partnership with KFF Health News. That\u2019s a nonprofit newsroom reporting on health issues in America. The reporters at KFF Health News do amazing work \u2014 win all kinds of awards every year. And in a little while, you\u2019ll meet the KFF reporter who introduced me to Noah Hulsman and Nicole Wipp.<\/p>\n
Dan:<\/strong>\u00a0Before Nicole Wipp knew that her Obamacare rates would be going up, she knew she was pissed at what she calls the insurance industrial complex.\u00a0<\/p>\nNicole Wipp:<\/strong>\u00a0So my son. Just for example, we took him\u2014 called in advance, \u2018do you take our insurance?\u2019 Took him to get basic well child vaccines. Well, next thing I know, I got a bill for $4,000. I called them up and was<\/strong>\u00a0like, what is this?\u00a0<\/strong><\/p>\nDan:\u00a0<\/strong>She says that was early 2025, and she\u2019s been fighting ever since.\u00a0<\/p>\nNicole Wipp:<\/strong>\u00a0They\u2019ve cut it down to like 1200, but I\u2019m like, no, no, no, no, no. It should be a hundred percent covered under our insurance, So that\u2019s the thing is like, why would I participate in this?<\/strong><\/p>\nDan:<\/strong>\u00a0And at least since her half-a-million-dollar medical adventure Nicole Wipp has been pretty determined to live life on her own terms.<\/p>\nEven before her illness, she had already been trying to spend less time running her law practice and more time with her family.<\/p>\n
Then, after the illness, she more than doubled down on that. On her website, she says she went from working 80 hours a week to working just five days a month.<\/p>\n
That\u2019s the website for a new business she started after her recovery: a consulting and coaching practice that offers to help people achieve financial success on their own terms.\u00a0<\/p>\n
Nicole Wipp:<\/strong>\u00a0Financial success for me is very much not just about money, it\u2019s really more about quality of life and having enough money to have that quality of life.<\/strong><\/p>\nDan:<\/strong>\u00a0So, for instance, about four years after her illness, Nicole\u2019s family moved from Michigan to Hawaii.<\/p>\nNicole Wipp:<\/strong>\u00a0We said, we want to live in Hawaii because we wanna have a quality of life. And of course, living in Hawaii is not cheap. It\u2019s one of the most expensive places in the United States to live.<\/strong><\/p>\nDan:<\/strong>\u00a0But that\u2019s what they wanted. And they made it work.\u00a0<\/p>\nAnd then their son got into polo. Like, with horses. Which is harder to do in Hawaii\u2014 to do seriously, competitively \u2014 without a lot of traveling to the mainland. So they moved again, to South Carolina.<\/p>\n
Nicole Wipp:<\/strong>\u00a0And we did, by the way, when we moved back to the mainland, FedExed four horses from Hawaii<\/strong><\/p>\nDan:<\/strong>\u00a0Oh my God.<\/p>\nNicole Wipp:<\/strong>\u00a0I know, and like when you say, all these things, it sounds insane, right? It is insane.\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0Since then, she says they\u2019ve picked up another four horses.<\/p>\nNicole Wipp:<\/strong>\u00a0Now we have a total of eight, which is a lot, a lot by the way. Um, and so, you know, I say it out loud and I\u2019m like, oh, I\u2019m not proud of this, to be honest with you. But, but we have also though made other choices like we live in a smaller home than we would otherwise, so that we can do that.<\/strong><\/p>\nDan:<\/strong>\u00a0And that home is in a part of South Carolina where houses aren\u2019t super- expensive. So Nicole says the mortgage on their house is less than the $1400 they would\u2019ve been paying if they\u2019d kept their insurance this year.\u00a0<\/p>\nThe expensive horses, the less-expensive home\u2026<\/p>\n
Nicole Wipp:<\/strong>\u00a0 Like these are choices that we\u2019ve made as a family that I understand very much that most people would never make these choices, but we\u2019re doing it in as responsible of a fashion as we possibly can.<\/strong><\/p>\nDan:<\/strong>\u00a0A few years ago, her husband changed careers\u2014 no more job-based health coverage. They started buying insurance on the Obamacare exchange.<\/p>\nBut by mid-2025, it started looking like that insurance could get a lot more expensive. Not because they\u2019d lose a subsidy \u2014 they hadn\u2019t qualified for a subsidy to start with.\u00a0<\/p>\n
But if subsidies went away, she figured rates would go way up.\u00a0\u00a0<\/p>\n
Nicole Wipp:<\/strong>\u00a0I started bringing it up to my husband. Like, I don\u2019t know what this is gonna look like. I\u2019m very worried about it. And we may be in a situation where we need to make a choice\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0Could they contemplate doing without insurance?<\/p>\nNicole Wipp:<\/strong>\u00a0And so we had probably, you know, 20 conversations, at least, about it.<\/strong><\/p>\nDan:<\/strong>\u00a0Before making a decision \u2014 even before 2026 rates got posted \u2014 Nicole and her husband started taking some steps. She scheduled a colonoscopy, and went to the dermatologist for a skin check. Her husband got some tests too.<\/p>\nIf they didn\u2019t have insurance next year, those tests wouldn\u2019t be covered. And if any tests came back with scary results, insurance would be more important.<\/p>\n
Obamacare premiums for 2026 got published. Their family\u2019s rate would go up by about 50 percent.\u00a0<\/p>\n
Nicole Wipp:<\/strong>\u00a0Once the numbers came out, I was like, I just don\u2019t know if this makes sense.?But we were like, okay, we need to gather more information. We need to think about it some more.\u00a0<\/strong><\/p>\nDan:\u00a0<\/strong>Their tests had come back OK. And they felt fine. Maybe they wouldn\u2019t need any medical care in 2026, or not much. But maybe they would. How might they pay the bills? They kept talking. And they identified some ideas.<\/p>\nFor one thing, Nicole found some money socked away in a health savings account from her husband\u2019s old job.\u00a0<\/p>\n
Nicole Wipp:<\/strong>\u00a0It\u2019s not a lot, but it was like, oh, that\u2019s a nice little cushion. Like we could use that if we needed it.\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0Nicole figured, if they were paying cash, she\u2019d be in a good position to negotiate with providers for discounts.\u00a0<\/p>\nNicole Wipp:<\/strong>\u00a0Because I\u2019m a lawyer and I\u2019ve been around the block on these things, so I had a lot of faith that I could negotiate a bill.<\/strong><\/p>\nDan:<\/strong>\u00a0And she had other ideas for finding deals.\u00a0<\/p>\nNicole Wipp:<\/strong>\u00a0I was like, you know, depending on what the situation is, we could fly to another country, receive healthcare quality healthcare. It still would be less. And I am not above doing that.<\/strong><\/p>\nDan:<\/strong>\u00a0And if all of that required more cash than they had lying around, Nicole figured, they still had options.\u00a0<\/p>\nNicole Wipp:<\/strong>\u00a0We have certain assets that in an extreme emergency we could sell \u2013 I mean, because it\u2019s not just the horses. We have horse trailers and like, you know, there\u2019s a lot that goes along with all of that that isn\u2019t just the horses by the way.<\/strong><\/p>\nDan:<\/strong>\u00a0None of which made the decision easy. Nicole says she and her husband didn\u2019t fully decide until the actual deadline came for signing up. Even then, they knew they were gonna keep their son insured.<\/p>\nNicole Wipp:<\/strong>\u00a0I would be in my opinion, not responsible as a mom, so\u2026 because he does play a very dangerous sport.<\/strong><\/p>\nDan:<\/strong>\u00a0But for the adults, they weighed the risks, and decided to gamble.<\/p>\nNicole Wipp:<\/strong>\u00a0If I take that money and invest it instead of putting, I don\u2019t know, am I gonna be out further ahead? I will if I don\u2019t have a massive emergency and a half a million dollar illness. Um, right? And so it\u2019s a gamble, like, right? All of this is a gamble, but it was a gamble that I was like, I just don\u2019t want to participate in this any longer because this is not workable for almost anybody, but it certainly isn\u2019t workable for me anymore mentally or emotionally.<\/strong><\/p>\nDan: Not workable for almost anybody.\u00a0<\/p>\n
[Music transition]<\/p>\n
Renu Rayasam:<\/strong>\u00a0I mean, I also think about this as a reporter. We have these individual stories. What do they mean? First of all, why is this system like this and what does it mean for everyone?<\/strong><\/p>\nDan:<\/strong>\u00a0That\u2019s Renu Rayasam. She\u2019s a senior correspondent with our partners at KFF Health News. She introduced me to Nicole and to Noah. She and her colleagues have been talking with dozens of people about the choices they\u2019ve been forced to make about insurance this year.<\/p>\n?And thinking about what those individual stories mean has led Renu to some big reflections.\u00a0<\/p>\n
Renu Rayasam:<\/strong>\u00a0I think sometimes in the US you take for granted the way things are. Just you don\u2019t, you don\u2019t realize there is another way, you know? There is another way! And um, and that\u2019s where everybody has health insurance and those costs are better spread out.\u00a0<\/strong><\/p>\nDan:\u00a0<\/strong>Renu is speaking in part from experience. She spent a half-dozen years living in Germany. We talked about her experience\u2014 and how it affects the way she sees stories like Nicole\u2019s and Noah\u2019s.\u00a0<\/p>\nRenu Rayasam:<\/strong>\u00a0?Well first of all, it was kind of amazing to like never get a medical bill. Like that was like, like so mind blowing that you just, like, you go to the doctor and you never get a bill.\u00a0<\/strong><\/p>\nDan:\u00a0<\/strong>Not because the government pays for health care. But because the government requires everybody to have health insurance.\u00a0<\/p>\nRenu Rayasam:<\/strong>\u00a0 People pay premiums. ?You have to pay into the system. And it\u2019s not necessarily cheap either.??But then on the back end, you\u2019re never worried about, oh, my shoulders hurt, I have to get this MRI and I\u2019m gonna get a bill.<\/strong><\/p>\nDan:<\/strong>\u00a0?Most people pay a government-set rate \u2014 about 15 percent of their income. Most insurance funds are non-profit. Everything\u2019s highly regulated, and everybody gets the same benefits. Here, things are \u2026 more chaotic. Less predictable. People have to make hard choices\u2014 and those choices feed back into the chaos.\u00a0<\/p>\nRenu Rayasam:<\/strong>\u00a0So if somebody like Nicole opts out of health insurance, they\u2019re not paying into this system and the people who are paying into the system are people who need care. And so that makes health insurance more expensive generally.\u00a0<\/strong><\/p>\nDan:<\/strong>\u00a0Because insurers set their rates based on how much they expect to pay out. When healthy people bail, the rates go up. And when rates go up, healthy people bail. They reinforce each other. It\u2019s what experts call a death spiral.<\/p>\nAs some of those experts told Renu, a version of that happened over the last year. ?It wasn\u2019t a coincidence that insurers jacked up prices when subsidies were on the chopping block.\u00a0<\/p>\n
Renu Rayasam:<\/strong>\u00a0Part of the reason that insurers raised their prices was because they expected people to drop plans and that fewer people would be paying their premiums and be paying into the system.<\/strong><\/p>\nDan:<\/strong>\u00a0And people like Nicole and Noah ended up with lousy choices to make.\u00a0<\/p>\nNoah chose to keep paying for insurance as a backstop against absolute financial catastrophe \u2014 even though the insurance he can afford doesn\u2019t give him access to medical care he needs.\u00a0<\/p>\n
Nicole and her husband think they\u2019ve got the resources to pay for ordinary medical care. Even maybe a big medical deal \u2014 as long as there was time to hop on a plane and get to a country where they could afford treatment.<\/p>\n
But they\u2019re not protected against the worst. Nicole knows bankruptcy is a real possibility.\u00a0<\/p>\n
Nicole Wipp:\u00a0<\/strong>We don\u2019t have a guarantee. And it still weighs on me every day that I made this choice because it feels fraught. Do I regret it? No, not at the moment. I don\u2019t. Will I regret it? I hope not.<\/strong><\/p>\nDan:<\/strong>\u00a0Hmm.<\/p>\nNicole Wipp:<\/strong>\u00a0I don\u2019t know though.<\/strong><\/p>\nDan:<\/strong>\u00a0Yeah, you\u2019re not like, I did it. I\u2019m free, you know, this is the best. It\u2019s like, no, you\u2019re not free of it.<\/strong><\/p>\nNicole Wipp:<\/strong>\u00a0No, I don\u2019t feel free at all.<\/strong><\/p>\nDan:<\/strong>\u00a0I wish I had a snappier ending to this story. We are more stuck than ever \u2014 all of us \u2014 making messy choices, hoping for the best. So I\u2019m gonna give Noah the last word here.\u00a0<\/p>\nHe\u2019s taking his own advice: Taking things as they come, recognizing what\u2019s ridiculous, and aiming to hang in there for the long term.<\/p>\n
Noah Hulsman:<\/strong>\u00a0?Hopefully we, you know, get enough equity in this building that once it\u2019s time to pass the skateboard shop on, maybe sell the building and hopefully that\u2019s when we get to maybe cash out and go to the beach.\u00a0<\/strong><\/p>\nDan: Wow.\u00a0<\/strong><\/p>\n