The Long Islanders whose health insurance increases are central to the shutdown debate

Central to the showdown driving the federal government shutdown are health care costs that would rise significantly for millions of Americans, including nearly 100,000 Long Islanders.

Those who have benefited from more generous health insurance subsidies put in place in 2021 — and set to expire Dec. 31 — include independent contractors, freelancers, gig workers, small-business owners and employees of companies that don’t offer health insurance.

Republicans say the issue of extending the additional aid for people with coverage under the Affordable Care Act, also known as Obamacare, should be separate from keeping the government open.

While some support a temporary extension, GOP lawmakers say the subsidies — which were passed in 2021 and added to existing aid — were not meant to be permanent and point to the cost, an estimated $335 billion over 10 years, according to projections from the nonpartisan Congressional Budget Office.

Democrats have refused to vote for a government spending bill unless the enhanced benefits, in the form of tax credits, are made permanent and Medicaid cutbacks are reversed.

Democrats have said that the subsidies are crucial in allowing many low- and middle-income people who make too much money to qualify for Medicaid to afford health insurance.

Newsday talked with three people who would see an increase in premiums if the enhanced subsidies aren't extended.

Krystal Wolfe

Krystal Wolfe of Seaford earns under $40,000 a year as a tutor and retail employee. If enhanced Affordable Care Act subsidies end, she'd go from paying nothing in premiums to potentially hundreds of dollars a month.

"I’m going to have to drop insurance" despite needing treatment for an autoimmune disease, she said. "I can’t afford to pay it. I live paycheck to paycheck right now with that income as it is. There’s nowhere that money would come from."

Wolfe, 36, currently is on the state’s Essential Plan, which offers $0 premium insurance to people with modest incomes who make too much to be eligible for Medicaid. After Congress eliminated federal funding for the Essential Plan in July, the state said that as of July 1, 2026, it could no longer provide $0 premiums for people like Wolfe who earn between 200% and 250% of the federal poverty level, or up to $39,125 for an individual. Wolfe said she is at the upper end of that range. 

Wolfe would qualify for tax credits through the ACA — but they’d be much lower if the enhanced subsidies aren’t extended.

She said she might be able to swing up to $100 a month in premiums, although she’d likely need to ask her mother and grandparents — with whom she lives — if she could contribute less to her share of utilities.

Currently, someone in Seaford earning 250% of the poverty level — which is about Wolfe’s income — would pay an average of about $126 a month with subsidies and $778 a month without them for a midtier plan, and less for the cheapest plan, according to an online calculator from the health policy nonprofit KFF. Even if the enhanced subsidies aren’t extended, Wolfe would pay far under the market cost because she’d still be eligible for some assistance, but her premiums likely would increase significantly. 

For her Hashimoto thyroiditis disease, Wolfe needs to take a thyroid medication every day and go to the doctor twice a year for blood tests. If she doesn’t take her medication, "it would cause my immune system to go haywire because the thyroid wouldn’t be working properly," she said.

She’s noticed in the past that when lower dosages of the drug had waning effectiveness, she got very lethargic, cold and hungry. It would be worse without the medication at all, she said.

Without sufficient subsidies, "I don’t know how I could go without health insurance, and I don’t know how I would be able to afford it," she said.

Chris Rinaman

Chris Rinaman, a trombone player who makes a living from weddings, concerts, Broadway shows and other temporary gigs, pays about $350 a month for partially subsidized health insurance through the Affordable Care Act marketplace. His cost without subsidies would be roughly $600 a month, said Rinaman, 51, citing a figure he saw when signing up for coverage on the state's ACA marketplace.

So the Long Beach man is carefully watching discussions in Washington on whether to make expanded ACA subsidies permanent.

"The unpredictability is very nerve-wracking," Rinaman said. "It makes it hard to plan."

Every year, he must estimate his uncertain income. Sometimes he has to pay back part of his subsidies, when his income ends up being higher than expected.

He’s looked at unsubsidized, non-ACA options, and they’re far too expensive — $650 a month when he looked a few weeks ago.

Rinaman, who considers himself middle class, said the tax credit helps him navigate the high cost of living on Long Island.

"Especially in New York, it just helps with surviving," he said.

Rinaman has accessed health care through ACA since coverage under the law went into effect in 2014. He recalled how his premiums dropped significantly after the subsidies were increased in 2021. He’s worried about premiums rising sharply if the enhanced subsidies aren’t extended.

"I’d have to cut back," he said. "I don’t know on what. It has to come from somewhere."

Linda McIver

Linda McIver, a house cleaner with fibromyalgia and rheumatoid arthritis, said the enhanced Affordable Care Act subsidies are critical to allowing her to make ends meet.

Talk of reducing subsidies "makes me nervous. It would dramatically change my finances," McIver said as she strolled along the Long Beach boardwalk with a cousin from Holbrook on a recent sunny afternoon.

McIver, 63, a former Hempstead Town resident who now lives in Spring Hill, Florida, said she pays $120 a month for insurance, "and it’s pretty good coverage."

Similar insurance would cost about $500 a month outside an ACA marketplace, she said. If she had to pay that much, "I wouldn’t be able to afford health insurance," said McIver, who earns about $50,000 a year.

Yet she said she needs insurance, especially because of her health conditions. But if she didn’t have it and "I were hospitalized or had a car accident, I don’t know how I would be able to pay the bill," she said.

McIver said she is a Republican, although she’s "not a Trump fan" and leans independent these days. She said she doesn’t like how Republicans are resisting Democratic efforts to extend subsidies.

A family member who she said makes well into the six figures has bluntly told her that he doesn’t believe the government should help pay for her health care coverage. But, she said, the cost of insurance "should be based on income. I should not be paying the same price for health insurance as someone who makes double my pay, double my salary."