- Just ahead on Black Issues Forum, a new year usually comes with new goals, but for millions across North Carolina and the country, 2026 has also arrived with the harsh reality that healthcare is getting more expensive, and for some, drastically so.

We're breaking down why this is happening, what policy decisions are driving these increases, and what real options exist for individuals and families trying to stay covered and healthy.

Coming up next, stay with us.

- Quality public television is made possible through the financial contributions of viewers like you, who invite you to join them in supporting PBSNC.

(upbeat music) ♪ - Welcome to Black Issues Forum, I'm Kenia Thompson.

Well, many rang in 2026 with the reality that health insurance premiums have increased by as much as 36% in certain plans.

That's not a small adjustment, and for many who are already stretched too thin financially, it's forcing difficult choices between medical care, rent, food, or childcare.

We're breaking this conversation down into two parts.

First, why is this happening, and how policy and funding decisions impacting healthcare costs are happening, and then, what can you actually do, what are your options?

But right now, we're going to discuss the why.

I wanna welcome North Carolina Senator Natalie Murdock and Rebecca Cerese, Senior Health Policy Advocate at the North Carolina Justice Center.

Thank you both for being here.

- Hi, thanks for having us.

- Yes, so this is a very timely conversation.

We were just saying, I mean, you know, typically we kinda have a, maybe a week after something happens, right?

But January 8th, that was yesterday for us at this time of recording the House green lights ACA subsidies, right?

Extension, 17 Republicans backed this.

Tell me about how significant this is, but what happens when we get to Senate?

- Yeah, I mean, at least we're starting this year with some good news.

Late last year, the U.S.

House filed something called a discharge petition, and that simply means legislation that has been previously passed, or previously tabled, or just didn't make it to either the House or Senate floor, you'll have the opportunity to review that legislation again.

We have the same rules here in North Carolina.

And so that discharge petition passed out of the House at the end of December, but the House didn't take it up, so they came back first week of this month.

And a huge shout out to Congresswoman Lauren Underwood, who made it to Congress in her 30s.

She's the youngest black woman ever to make it to Congress, and is also a nurse, and worked on ACA, I believe, in her 20s.

And so full circle moment, the bill she filed to extend these tax subsidies.

And the reason that it's so important, it's a key part of what makes healthcare affordable.

So without those subsidies, what we'll be talking about today, that is why you're seeing this increase of the double and the tripling of out-of-pocket costs and premiums, because you've had the federal government, essentially a cost-match system to keep costs low with the federal government having coverage for some of this cost.

And without that, as a result of the legislation from last year, that is what is gonna cause these health premiums to skyrocket beginning this year.

- Yeah, Rebecca, some Republicans say that this was a COVID-19 era fix, that it no longer has place now.

What are your thoughts about that?

- Well, healthcare has not gotten cheaper.

And health insurance hasn't gotten cheaper.

In fact, it's all gone up.

So these are obviously still needed.

I just wanna clarify, too, there are still some subsidies available.

They didn't all go away.

And we have till January 15th for people to see if they're eligible for any subsidies to choose a plan that would start February 1st.

It's the enhanced subsidies that were enacted during COVID-19 to ensure that more people could stay on insurance.

It basically extended who was eligible for these subsidies, even people with higher incomes, because we know, like, even if you have a higher income, these premiums, these monthly premiums are really, really high.

So it, like, put a limit, so you can't pay more than 8% of your income for these premiums.

So it helped a lot more people.

And so that's who's being impacted now.

So you're seeing so many more people now with sticker shocks saying, "I can't afford the plan."

- That's me.

- Absolutely.

- I'm double in the new year.

- Absolutely.

- So what are driving these costs, Senator?

- There's so many things that are driving the higher cost.

But I cannot stress enough the impact it's gonna have on North Carolinians.

So in North Carolina alone, the loss of those enhanced subsidies to offset those higher costs will impact almost 900,000 people just in North Carolina alone.

And that is in addition to cost of housing going up, even your car insurance, every form of insurance is going up.

And so when we talk about affordability, healthcare is a key component of it.

That is why you saw that standstill and why we had a government shutdown.

This was the crux of why we did that.

And that is why you saw some Democrats to vote to open the government up again, hoping that this is what would happen.

But a lot of what's driving up the cost is just inflation overall.

Everything is more expensive.

Every piece of equipment, medication, cost of labor, the cost it takes to even maintain medical facilities, all of that is going up.

So if you have inflation in every other aspect of the economy, healthcare is not going to be saved from that.

There are more things that we can do at the state level, but the same gridlock you're seeing in Washington, DC, you're seeing in North Carolina, you've had proposals come out of the state Senate and the House, and some are good.

None of them have made it to the governor's desk.

The only true relief we have seen, luckily Governor Stein along with DHHS are providing some relief for medical debt.

- No, that's good.

Rebecca, when we think about how this impacts families, we're seeing, although not official, threats to childcare subsidies happening right now.

Like you said, food costs are increasing.

How does this directly impact our black families in particular, especially in rural areas where healthcare access is already at issue?

- Well, unfortunately, like every single thing in our inequitable racist society, it disproportionately impacts black families.

Unfortunately, black families face higher levels of medical debt, higher levels of uninsured rates, and so many things like that.

Plus, if you're in rural areas, it's just those rural hospitals are working on razor thin margins anyway, and so if we have more uninsured people, so if people decide I can't afford these insane premium increases, and instead I'm going to take a risk and be uninsured, and then something happens, they still need care.

So they end up in the emergency rooms, the most expensive care, and that really impacts our rural hospitals in particular who are already operating on those razor thin margins.

I also wanted to say though, in terms of what's driving costs, because sometimes we forget this.

We have the corporatization of healthcare, and we have a profit-centered healthcare system.

We are an outlier in the developed world, and it always seems like it's the elephant in the room that no one wants to talk about.

But if profit is at the center, that is there's a perverse financial incentive to deny people care or to jack up prices on things like monthly premiums.

These are for the most part for-profit insurance companies or not-for-profit insurance companies that act as for-profit insurance companies that are looking to make a profit.

And when you have profit at the center instead of patient care, we're not actually having the right priorities.

- Right.

So as we, I don't know what the numbers look like.

I was doing some research.

I hear what people are saying, right?

They are making that decision to drop health insurance.

If that happens en masse, earlier we were talking about other resources and options.

Tell us what some of those options are, but I also want to focus on what happens, and is there anything in place policy-wise for an overflux or an inundation of folks going to these free resources?

Are they able to support?

- Yeah, really good question.

So there are resources.

I just want people to know that even if you don't have insurance, you don't have to wait till you're so sick in the emergency room.

We have amazing community health centers that see people on a sliding scale.

There are free and charitable clinics that you can find.

There's community health centers or county health centers that have limited things that you can do.

The medical debt program that Senator Murdock just talked about that is unique to North Carolina actually has expanded who is eligible for financial assistance if you actually seek medical care in a hospital setting.

So if you need to go to the hospital, always ask, can you screen me for financial assistance?

The hospitals are supposed to do that automatically, but they don't all-- - - But they won't prompt it themselves though.

- But they don't all do it.

So the more people can be empowered to advocate for themselves, the better off we are.

And to your other point, yes, we need to invest in this infrastructure, our healthcare systems.

And unfortunately, we don't have a budget in North Carolina.

We're the only state that doesn't.

And we also are gonna be running into a revenue problem because we keep cutting corporate tax rates for corporations that actually should be actually paying more or their fair share because they're using our infrastructure, they're using all of our things, they should be paying that because we need revenue, we need to invest in the things that we need to meet our basic needs.

- So when we look at what's happening on the federal level, how does that intersect with what's happening here in North Carolina?

Are we mirroring things?

- Yes, direct impact, which is why we can't stress enough, and to be clear, we are not at the finish line.

That ACA enhanced subsidy bill made it out of the House.

It still has to make it out of the Senate, which will be even more challenging.

- What's the challenge specifically?

- The challenge will be finding enough Republicans to sign on, and the rules are different in the various chambers, so the rules in the House are not the same as the Senate.

The Senate is a very different body that operates in a very different way, and it will be challenging to get it even to the floor for a vote the way that they did in the House on last night.

So that's a big piece of it, since again, we'll have over 800,000 folks here in North Carolina that immediately will feel that increase.

We also, at the state level, have not fully funded Medicaid.

The fancy word is Medicaid rebates, but it's essentially paying all of our Medicaid bills to cover who's already on Medicaid.

So also as a result of the huge bill out of D.C.

from the last session, that means that long-term, Medicaid is not gonna be as stable as it was in addition to our inability to have a state budget.

At a minimum, we should already have done this, but need to add around $150 million to Medicaid just to cover current Medicaid services.

This is not new service, this is just to keep up with current demand.

And also as you project into the future, a huge aging population, we have a growing number of folks that are 85 and up, people are living longer.

So we've really gotta figure this out.

Our overall system is crumbling.

You can say it will be bankrupt at some point.

When you look at the state alone, Health and Human Services does not have an Amex to just keep swiping a card of unlimited money.

The state has to appropriate these dollars and do our job.

So I wish, like U.S.

House, we would have gone back this week to say we're gonna fully fund Medicaid.

So the juxtaposition of all those issues is really putting a lot of strain on the state, but we've gotta have a federal partner, we can't do it by ourselves.

- Some argue, Rebecca, that we should have free healthcare in this country.

I do believe we should, but nothing is really free.

So explain to us what free healthcare would look like and what does that actually mean and who's paying for it?

- Absolutely, so like you said, nothing is free.

When we talk about other countries that offer healthcare to their people as a right, they use it, usually fund it through progressive taxation.

And I will tell you this, we actually pay more than double of other developed countries for healthcare.

We have worse health outcomes, we're getting a terrible return on our healthcare dollar.

We do it incredibly fiscally irresponsibly.

So I do believe that we need to have a thoughtful, well thought out hearings, committee hearings where we talk about how we can do healthcare in a better way.

Progressive taxation is a way to do it.

People that can pay more should pay more.

Most people would actually pay less if we had a single payer system.

We also have profit at the center of our healthcare system.

- Define a single payer system for those of us.

- So right now, we have a million different payers.

So we have Medicare, Medicaid, Indian Health Service, the VA, and a million private insurance companies.

So that's a multi-payer system.

What does that do?

It adds all this redundancy, bureaucracy, waste, inefficiency to the system right now.

So we are spending like so much of our healthcare dollar, probably 30 cents of every dollar, just on the administration cost, which is not going to healthcare, right?

Which is not actually helping people stay healthy, right?

And if we were able to go to a single payer system where we had one entity that pays for our healthcare, that would be much better.

Also, everyone would be in one giant risk pool.

What happens when you do that?

One giant risk pool actually lowers the cost for everybody.

That's how insurance works.

We would actually have more choice because all the doctors, hopefully all the hospitals would be in one network.

Right now we have the limited network.

- Yeah, well, so much to pack in.

We still got to talk about options for solutions for those out there that may need different choices to make.

But I want to thank you both, Senator Murdock, Rebecca Cerese, thank you.

I know that we'll revisit this conversation again.

So there's more to come.

- More to come.

- More to come.

So we've talked about why healthcare costs are rising and how policy decisions ripple into people's everyday lives.

But understanding the problem is only half the story.

Before we shift gears and move into practical solutions, I wanted to give the opportunity to hear the voices of Republican legislators that support the removal of these subsidies.

Additionally, we'll hear from Senator Bernie Sanders, who will be reading letters from Americans voicing concerns about those changes.

Take a look.

- Can't fix this program.

I mean, you can't just do a blanket extension without reforms.

It is rife with waste, fraud, and abuse.

- The Republican plan is to put the money into the patient's pocketbook so that she has money to pay for the insurance out of pocket.

- I made a request to people all over this country to send us their stories in terms of the impact that the Republican legislation would have on their lives.

So let me read just a few of them.

My husband and I own a small business in Texas.

My husband and I are on the ACA.

I have lung cancer.

I will lose my coverage due to the increase as it already has high premiums.

I will die without healthcare, and so will many others.

Jen from New Mexico writes, and I quote, "Ours would more than double in New Mexico.

"Our premiums would increase $600, "from $600 to $3,800 for the same policy.

"We have a family of three.

"If the enhanced subsidy goes away, "that's what will happen."

Hayet from Florida writes, "If my health insurance costs go up, "I won't be able to have health insurance at all."

- Well, if the first half of this conversation left you thinking, all right, well, what do I do now?

This next part is for you.

Joining me now is Connie Bryant.

She is a health insurance advisor who helps individuals and families navigate their options every day.

Welcome.

- Thank you, Kenia.

- That was a tough piece to watch.

Hearing those stories, it's a reality for so many North Carolinians, so many people in America.

I myself have experienced a doubling of my health insurance, making me question, is this something I can afford going forward?

But knowing my medical situations, I can't afford to not have health insurance.

Give me your thoughts on just the reality of where we are today.

- The reality is a lot of people are struggling.

And I encourage everyone to know that they're not alone.

First of all, it's important to have information.

And there are a lot of resources to find information.

And one of the key things that I find in my work is that people don't understand certain concepts.

And one concept is that there's healthcare and there's health insurance.

Healthcare is what your health providers do with you and for you to keep you healthy.

Health insurance is a financial tool that enables you to afford to pay for your healthcare and protects you from financial ruin if you have high healthcare bills.

So it's important to know the difference and always look for healthcare at the earliest time possible.

- So let's say we've got a viewer similar to my situation who their premiums have doubled.

They are at that point now where they have to make a decision.

Am I going to keep this, work more, stress more, or am I going to get rid of it, still stress, still work?

What options are there and how do we make that decision soundly?

- Okay, with health insurance, the premium is a big factor that people worry about or stress about.

But it's important to know what's underneath that.

So what are your deductibles?

Which doctors can you see?

What medications can you take?

And you can actually sometimes reduce your premium by taking a little bit more risk.

And also there's also statewide and community programs that can help you with your healthcare.

So it's important to know the difference and talk to someone who is able to explain this in plain language so that you're able to understand it and make a good choice for yourself and for your family.

- Well, one thing I noticed in doing a little shopping is that you're right, there are some monthly premiums that are cheaper.

However, kind of being spoiled, I guess, if you wanna use that word, of having employer-provided insurance plans that have a lower deductible, lower out-of-pocket co-pays, seeing the lower monthly premium but the higher out-of-pocket costs concern me.

But what you're saying is it's okay to take a risk in that way?

- So it depends on your health, right?

So when you look at health insurance, most of the time you're trying to protect yourself from the risk of high expenses.

So there's different ways you can do this.

We have community clinics that do sliding scale kind of payments based on your income.

We also have areas whereby if you get good preventive care, you sort of try and avoid or come in front of high healthcare costs.

The other thing that I encourage people to do is also look at different ways that you're able to manage that risk with financial tools.

So there are some financial tools that you can use like indemnity plans.

So those are areas that you can work with a trusted healthcare insurance advisor who will be able to explain those so that you're making an informed decision on how you layer yourself and protect yourself.

Because the important thing is always go for healthcare.

Make sure you go see your doctors when you need to see them and not in the end.

- Now, those options that you provided, the community resources, do we have to have health insurance to be able to benefit from those?

And then how do you find the right place for you in your area?

- So there's different resources that are state funded.

There's also nonprofits that give you resources that you're able to work with.

We also have what we call the department, the North Carolina Department of Insurance, and it helps you find trusted advisors to help you on the insurance path.

So there's different ways that you can find this.

One thing that I like to do is making sure our community understands that there's help out there and you're able to manage your risk differently.

And it's not a one size fits all.

So knowing your situation, knowing your risk, 'cause you just talked about your health situation, knowing your health situation is the first thing.

And then also being able to protect yourself and getting information from trusted advisors is very important.

- Now, what if we've got folks who are similar to, I think that first story was someone who had cancer, lung cancer, I think it was, who have, I mean, they've got to get care or else things may not look favorable for them, but they don't have the finances or funds.

What are maybe some of the, how do they kind of cherry pick what their options are to mitigate the financial impact but still receive the care that they need?

- My advice is first of all, get the care.

So I had a situation where I was speaking with someone whose mother was going through chemo and she was still getting her chemo, but the institution was continuing to ask her to pay.

So first of all, get the healthcare that you need.

Number two is there are areas where you can get debt relief or get some funding to help you with your healthcare if you're in a situation where you cannot physically.

Yes.

And if you're in a situation where you cannot afford premiums.

But my advice is health insurance should be one of the main expenses that you budget for, because just like you keep lights on and the water on, health insurance needs to be one of those because health bills is causing a lot of bankruptcies in this country.

67% of bankruptcies in this country are because of health bills.

We don't want to get into a situation where you get bankrupt because of health bills.

- Yeah.

Now, let's say you do have a medical debt with a hospital or a provider.

Are they still obligated to see you?

- Yes, they're obligated to see you.

But one thing that I like making sure my clients understand, if you have a bill, call the provider that has sent you the bill and try and work out a payment plan.

And then after that, see if you qualify for different programs to help you alleviate or reduce that debt, because there are resources out there to help you do that.

- And we also know that there's a difference between emergency room, urgent care clinics.

Should we be utilizing one more than the other?

- Absolutely.

Please use the community clinics because those are even cheaper for you and for the community to use and get your healthcare when you need it and not wait until you have to go to the hospital or the emergency room because that's the most expensive care that there is available.

- Yeah.

Well, when you talked earlier about, well, they talked earlier about potentially having to, well, January 15th is when I guess all decisions need to be made.

If folks still don't know what decision to make when it comes to their health insurance, is there an extension there or is there any wiggle room to make those decisions that are best?

- So it's important to try and keep to the deadlines because the deadlines sort of close the gates for what we call open enrollment, which is anyone can enroll.

But families need to understand that there's special enrollment periods.

So if there's changes in your income, if there's changes in your family situation, there are situations where you can be able to get health insurance outside of the normal cycle.

- Changes like change in health?

- So changes in income and change in a family situation.

So for example, if you have a new baby coming to the family or the family status changes or divorce is another situation.

So all these family situations allow you to get health insurance outside of the normal cycle.

- And if folks have missed the window, what happens there?

- There are ways in which you, there are programs.

So the marketplace is the one that has a finite window, but there are programs like Medicaid is another reason you can also get qualified.

You can also get financial assistance from nonprofits and also the debt relief system.

So there are other ways that you can be able to cover your health costs.

- Real quick, how can viewers find you if they've got more questions?

- Well, you can find me by following me on Instagram on Connie Bryant underscore.

You can call me at 919-995-9649, or you can visit us on our website, which is smartmedicareusa.com.

- Wonderful, Connie Bryant, thank you so much.

I appreciate you.

- Thank you for having me.

- Thank you.

And I thank you for watching.

I really hope this was helpful.

If you want more content like this, we invite you to engage with us on Instagram using the hashtag blackissuesforum.

You can also find our full episodes on pbsnc.org/blackissuesforum and on the PBS video app.

I'm Kenia Thompson, I'll see you next time.

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