ACA Premium Spike 2026: What Doctors, Residents & 1099 Physicians MUST Know. #473 Part 1

The Affordable Care Act marketplace is facing a massive premium spike in 2026 — and Congress is running out of time to stop it.
In this episode of Docs Outside The Box, Dr. Nii and Dr. Renee break down exactly why ACA premiums are increasing, what happens if Congress does nothing, and how this will impact:

• Medical students
• Residents & fellows
• Early-career doctors
• 1099 independent contractors
• Locums physicians
• Patients relying on marketplace plans

Whether you buy your own insurance or you care for patients who do — this episode gives you the real-world implications and action steps you need right now.

In This Episode You’ll Learn:

✔️ Why ACA marketplace premiums could jump 40–60%
 ✔️ How expiring federal subsidies affect patients AND physicians
 ✔️ Why independent contractors will feel the biggest financial hit
 ✔️ The impact on hospitals, uninsured rates & ER volume
 ✔️ What doctors can do NOW to prepare (financial steps included)

🎧 Perfect Episode For:

• Medical students navigating their first insurance decisions
• Residents & fellows in high-deductible plans
• New attendings planning their 2026 budgets
• Locums docs & 1099 contractors buying their own insurance
• Any clinician wanting clarity on the latest healthcare policy changes

FREE DOWNLOAD -  7 Considerations Before Starting Locum Tenens - https://darkos.lpages.co/7-considerations-before-locums

LINKS MENTIONED 

ACA Premium Spike Analysis — HealthSystemTracker
 https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026/?utm_source=chatgpt.com

Subsidy Expiration Breakdown — Center on Budget and Policy Priorities
 https://www.cbpp.org/research/health/health-insurance-premium-spikes-imminent-as-tax-credit-enhancements-set-to-expire?utm_source=chatgpt.com

Congressional Update on ACA Debate
 https://cnycentral.com/news/nation-world/congress-enters-crunch-time-to-figure-out-how-to-deal-with-aca-subsidies-affordable-care-act-obamacare-health-insurance-premiums?utm_source=chatgpt.com

Independent Contractors & ACA Tax Credit Changes
 https://jasonfintips.com/insurance-risk-management-blog/affordable-health-insurance-for-independent-contractors-understanding-the-new-aca-tax-credit-changes/?utm_source=chatgpt.com

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Transcript

ACA Subsidies Expire And Premiums Spike

SPEAKER_03 0:35

There are some subsidies out there that are helping a lot of Americans pay the premiums for their health insurance. So the subsidies are gonna go away. The same plan starting January 1st that we have that we pay$1,400 for is gonna be$1,700 a month.

SPEAKER_01 0:51

My God.

SPEAKER_03 0:51

Nothing changes at all. No body parts grow additionally.

SPEAKER_01 0:54

I might have to grow a new body part. I'd be good with an extra arm.

SPEAKER_03 0:57

To some independent contractors, that's gonna eat into their profits.

SPEAKER_01 1:00

Oh, victim. You are really going to be forced to be doing business as a business. If your costs are going up, you really have to see yourself more than just as, well, I'm the doctor and I'm here to see patients. You have to really start interacting with these hospitals as a business.

SPEAKER_03 1:17

On top of that, policy matters. You're gonna be affected by this. Like you cannot sit on the sidelines. And guess what? When patients can't afford premiums, guess what they do? They go to the ED. What up, everybody? This is Dr. Ni, joined by my co-host, Dr. Renee. Hope everybody's doing well. Uh, this is our first podcast after Thanksgiving. Um, we hosted Thanksgiving, it's busy, um, but it's a very important holiday for me and my family, uh, mainly because we don't get together too often. That's the one time where we all as a family get together and have dinner, break bread. And um, it was great this year. Yeah, it was. Great this year.

SPEAKER_01 1:54

My back was killing me.

SPEAKER_03 1:55

Yeah, you did a lot of cooking, and I definitely got to appreciate you for that. Um, big ups for you for doing um the diriapois, for doing the what's it, macaroni à grandin? Everything out there for the most part um was was great. And you did you spent a lot of time working on it? I appreciate you for that, yeah.

SPEAKER_01 2:12

Thank you.

SPEAKER_03 2:13

Alfred, let's get a let's get a round of applause for her, y'all. Please please.

SPEAKER_01 2:16

Yeah. Well, you cleaned up the place.

SPEAKER_03 2:18

Actually, no, you didn't.

SPEAKER_01 2:20

What do you mean?

SPEAKER_03 2:21

I didn't clean up.

SPEAKER_01 2:21

No, I mean before, remember all the stuff downstairs.

SPEAKER_03 2:26

Oh, yeah, yeah, yeah, yeah. Because we, you know, like you family, all like we rarely stay in just one place. So I just wanted to make sure that it was comfortable for people to roam around and go to the basement.

SPEAKER_01 2:36

Yeah.

SPEAKER_03 2:36

Go to the bedrooms, wherever they want to.

SPEAKER_01 2:38

A lot of stuff in the basement.

SPEAKER_03 2:40

Yeah, we got to get rid of a lot of shit. So yeah. But that's not what we're here for. We're here.

SPEAKER_00 2:44

What are we here for?

SPEAKER_03 2:45

We here for well, first of all, I want to thank everybody for tuning in on YouTube as well as on the audio experience. Um, I just want to say I appreciate everyone. We got a lot of feedback from the previous episode. Really? We had some friends even reach out just to be like, glad you guys are back.

SPEAKER_01 3:00

I think people sent out an APB on us.

SPEAKER_03 3:03

Yeah, yeah. We got text messages, uh, we got questions.

SPEAKER_01 3:07

Y'all okay?

SPEAKER_03 3:08

We got comments on YouTube that we're talking about. Yo, it's like that sometimes. It's like that sometimes. But we good. We gonna be good, but sometimes, you know, there's a little bit of, as they heard in the previous episode, too many irons on the plate. Yes, or on the stove, excuse me.

SPEAKER_00 3:25

Yes.

SPEAKER_03 3:25

And um, just want to say I appreciate everybody for tuning in because you know, this is the best doctor podcast out there, I'll tell you right now.

SPEAKER_00 3:33

You better be.

SPEAKER_03 3:34

And we keep it real.

SPEAKER_00 3:35

You better, you better keep it real. Yeah.

SPEAKER_03 3:37

So let's let's talk about real quick, briefly, what we're gonna talk about today. We're gonna talk about how the Affordable Care Act premiums that are gonna skyrocket in less than a month, how it's gonna affect us, how it's gonna affect those who are listening right now, and how it's gonna affect your patients. We're gonna answer a question from someone who wrote us a very, this is not a straightforward question. This is more of like a black and white in one respect, and then it's more of an emotional question on the other. Um, basically, it's about how PSLF and being a first generation immigrant and being the only doctor in your family, how that all relates and tracks, and then that's pretty much it. We're gonna get out of here after that.

SPEAKER_01 4:14

Okay.

Meet The Hosts And Holiday Catch‑Up

SPEAKER_03 4:14

All right. Um, so let's jump into this. So let's talk about ACA premiums. Um, if you guys have been living under a rock, for those who've been living under a rock, um, the reason why, the main reason why um the government went into a shutdown is there's going to be or there are some subsidies out there that are helping a lot of Americans pay the premiums for their health insurance. And a lot of these folks get their health insurance through the Affordable Care Act, through the marketplace, Obamacare, whichever word you want to use, um, if you're getting health insurance not through your employer, that's what the Affordable Care Act kicks in. That's how we as a family, yeah, since 2017, that's how we as a family get our health insurance. And basically we go on a website, we go onto New Jersey's website because we live in Jersey, and we look at all the different health plans. And it's just like anybody who's working right now and they have different tiers. They have a bronze plan, they have a silver tier, and then they also have a gold plan. And that's it. You pay your insurance. For those who are independent contractors, the 1099 docs out there, um, for even your patients, what ends up happening is you get some type of subsidy if you are a patient for the most part. If you're an independent contractor, for example, if you're a doctor, you probably don't qualify for a subsidy to pay for your premium, but um it there's a significant portion of that premium that you pay that is tax deductible.

SPEAKER_02 5:45

Right.

SPEAKER_03 5:46

Because the IRS looks at that as the cost of doing business. In order for you to work and provide your services at a hospital, you gotta have your own health insurance. Right? You are an employer.

SPEAKER_01 5:56

Nobody else is giving it to you.

SPEAKER_03 5:57

Right. So those premiums and those subsidies are gonna go reverse. So the subsidies are gonna go away starting January 1st. So that means that a lot of people are gonna be paying a shit ton of money now.

SPEAKER_02 6:09

Boom.

SPEAKER_03 6:10

The premiums are gonna go through the roof. And I'll just start with us. Actually, let's just be a mode of transparency. Um, so right now we're in open enrollment. By the end of this month, we've got to make a decision on our healthcare coverage. Um, so if you go to New Jersey's website, we currently play pay$1,400 a month for our health insurance, which a lot of people are like, good lord, that's a lot of money. Especially if you're employed, right? Your health insurance costs the same amount, but your job is probably paying either all or 50% of it. 50% of it, 60% of it. It's part of your fringe benefits. Right. Right. And then you pay a premium out of your paycheck. That's how it works. So that's why you probably are used to seeing like$300 or$400 or$500, depending on how many kids you got, right? I can make a joke there, but depending on how many kids you got. What joke? I don't know. Follow me. If you got a lot of kids, then probably your premiums are a little bit higher. If you don't, your premiums are a little bit lower. But either way, we pay$1,400 a month. So I went to the website to start enrolling us in for making sure we have a new plan because I'm also considering, you know, the kids are eight and six now. They're not going to the doctor as much, but because they're eight and six, they get on bicycles, they do a bunch of stupid shit, the likelihood of them going into the hospital and getting hurt. Right. Our kids are entering into that appendectomy stage. You know what I'm saying? Like they are, all of those different things are starting to come up.

SPEAKER_01 7:36

Sorry, I'm laughing because when I was little, when I was about nine or so, something happened with my dad's job or whatever, and we didn't have health insurance. Oh, yeah. And he'd be like, go inside. We don't have any health insurance. Don't cost us no money. Don't go falling outside. Go inside. Don't play outside.

SPEAKER_03 7:57

And back then there was no urgent care. There was just the ER. Just the ER, y'all. I remember a bike fell on my head. You be good. Tussing. Put some tussing on. You'd be all right. I actually needed stitches, but Okay, mom and dad will do it for you.

SPEAKER_00 8:11

No. They took me to the ER.

SPEAKER_03 8:13

No word. Get the janitor to do it. Even the janitor's prices are too high.

SPEAKER_02 8:20

You know?

SPEAKER_03 8:22

Well, listen, um, I was there too back in 1988 when my dad lost his job on Black Friday. Was it Black Friday? Black Monday.

SPEAKER_01 8:29

Black Monday. Yeah, Black Monday. Was it Black Friday is when you buy stuff.

SPEAKER_03 8:33

Yeah, I think it was Black Monday.

How Marketplace Plans And Tiers Work

SPEAKER_01 8:34

He definitely didn't buy nothing on Black Friday if he lost his job.

SPEAKER_03 8:37

Yeah, so he he lost his job and we same thing. Um had the same discussion. Hey, we ain't got no health insurance.

SPEAKER_01 8:44

Go inside.

SPEAKER_03 8:44

Stay inside, yeah.

SPEAKER_01 8:45

I think he was in the immigrants uh guidebook to survival.

SPEAKER_03 8:50

But so I went online to look at our health insurance because I'm thinking about increasing the premiums. But if we stay at our current what we have, which is the bronze tier plan. And the reason we do bronze tier is because we want to have a high deduct. We want to have a high deductible plan. Basically, we don't anticipate using the medical system. So we say, look, we'll have a high deductible.

SPEAKER_01 9:13

We don't anticipate using it as much.

SPEAKER_03 9:15

What did I say?

SPEAKER_01 9:16

We don't anticipate using the medical system.

SPEAKER_03 9:19

Okay. Well, we don't we don't anticipate you guys know what I'm talking about. They get what I'm saying, right?

SPEAKER_02 9:25

Okay, I just want to make sure.

SPEAKER_03 9:27

So as a result, our premiums are lower, right? But if something were to happen, we would pay a little bit more than somebody else who pays higher premiums. Right? My I'm tracking, right?

SPEAKER_02 9:40

You're tracking.

SPEAKER_03 9:41

So the same plan starting January 1st that we have that we pay$1,400 for is gonna be$1,700 a month.

SPEAKER_01 9:48

My God.

SPEAKER_03 9:49

Nothing changes at all. No body parts grow additionally. It's the same thing.

SPEAKER_01 9:53

I might have to grow a new body part.

SPEAKER_03 9:55

Well, that's$300 a month overnight. I'd be good with an extra arm. That is a 21% uh jump um in our uh deductible or in our premiums. Um so I'll just tell you right now, like, it's not just us. So any of the healthcare professionals who are listening who are independent contractors, uh those independent contractors who are not in healthcare, you know, those um what do you call it? Plumber, consultants, whatever it may be, um there's some residents who are in high deductible health plans, right? So they're like, well, I don't see the doctor much. I'm young, you know. They're going to see an increase in their premiums. Patients are going to see an increase in their premiums. So it's not just us. So we just wanted to share that it, you know, it it's affecting us, but it's also gonna be affecting you also.

SPEAKER_01 10:41

Yeah.

SPEAKER_03 10:42

Right. Um, so that's that's um that's gonna be a problem. Uh now we can handle that, obviously, right? But it's some to some independent contractors, that's gonna eat into their profits.

SPEAKER_01 10:54

Oh, big time.

SPEAKER_03 10:55

That'll eat into your profits. Um, and that might even cause some of y'all to come back to the negotiating table with some hospitals and be like, yo, you're gonna have to pay me a little bit more to offset the fact that I have higher costs.

SPEAKER_02 11:06

Right.

SPEAKER_03 11:07

So that may or may not put you in a good position, though. We'll see. We'll see.

SPEAKER_01 11:11

Yeah. Yeah. I think Well, I mean, I think that you're going to be much more forced, especially as physicians who are doing locums independent contracting, you are really going to be forced to be doing business as a business, right? Because this is what happens when you have businesses that have costs that increase.

SPEAKER_02 11:34

Yeah.

SPEAKER_01 11:34

Right. When everybody's talking about tariffs, tariffs. It's like, well, who's paying those tariffs? Because guess what? These businesses aren't going to necessarily take on all of the costs. So it's going to be kind of the same thing. If your costs are going up as an independent contractor, you really have to see yourself more than just as, well, I'm the doctor and I'm here to see patients. You're gonna have to really start interacting with these hospitals as a business.

Sticker Shock: Family Premiums Jump 21%

SPEAKER_03 12:02

Well, I I agree with what you're saying. I think even on top of that, policy matters. Right? Like you, I think the folks who are listening right now, if you're an independent contractor, or all you guys right now, whether you're a resident and so forth, you're you're gonna be affected by this. So policy matters. Like you cannot sit on the sidelines and either like not pay attention because in some form or fashion it's gonna affect you. It's gonna affect you as a locums doc. It's gonna affect you as an employee doc, it's gonna affect your patients. And guess what? Like when patients don't have can't afford premiums, guess what they do? Guess where they go? They go to the ED. So the whole point of the Affordable Care Act was to get them, you know, basic health insurance so that they can go and see a PCP. Right. So they're not in the ED as much. So they could go to urgent care, right? So this is all financially feasible. Now, all of a sudden you're telling me, well, it costs way too much for me to pay for my health insurance. I'll just do what I did before, or I'll do what someone else used to do, which is look, the ER is my PCP. Right. Right. So that's that's the problem. Like the the decisions or the inaction of Congress, it has real real effects on us. And we've had to have, or we're gonna have to have a conversation as to how we're gonna budget a little bit better. Because I I know you guys are like, well, you guys are two physicians, y'all got this and so forth. Yo, this stuff has real effects. Yeah. This has real effects, real consequences, right? For two docs who use you know what we get paid to not only keep the household going, but don't forget, like, we got retirement plans, we got all of these different benefits that if you are employed right now and you don't necessarily have to worry about, we have to worry about.

SPEAKER_02 13:39

Right.

SPEAKER_03 13:40

Right. And I think the majority of small businesses or small business owners would have to worry about also. So that's just one thing that you know is a little bit frustrating. Um, so I just wanted to pivot, and some people may be listening. Well, I get what you're saying, but tell me why. So I had to keep notes and I had to look it up because this stuff is a little bit confusing. So I had to keep notes. So the the point that I want to make is what's actually causing the premium spike. So the first one is a lot of these subsidies that came into place were around COVID. They're set to expire. And Congress is having a hard, well, Congress is deciding not to renew those subsidies. And as a result, the subsidies go down, more of the costs fall on the patients, more of the costs fall on us. Premiums are gonna go through the roof.

SPEAKER_00 14:29

Right, right.

SPEAKER_03 14:29

Right. Second, as always, what's always rising? Healthcare.

SPEAKER_00 14:34

Healthcare.

SPEAKER_03 14:35

Healthcare is always rising, the drug prices, how long, how much it costs to stay in a hospital. Yeah. Um, the operating costs for the hospitals. Don't forget the one big beautiful bill took a bunch of money from particularly rural hospitals. So as a result, the insurance companies they are raising their rates. And then healthcare insurance companies are also raising their rates. So it's frustrating.

SPEAKER_01 14:59

Yeah.

SPEAKER_03 15:00

And then insurance companies also on top of that are gonna say that well, more people are using insurance, so the utilization goes up, and who pays for it? We do. We do. Right?

SPEAKER_01 15:12

So But what happens when what happens when all of that falls into place and then less people are using insurance?

SPEAKER_03 15:20

And look, do I look like um Kaiser or I'm like Robert Wood Johnson? Like But um I I do agree with what you're saying, right? Like I don't know what that looks like. Is there a possibility?

SPEAKER_01 15:35

I don't think it will look any different. I think you know, the the the cost of everything will continue to go up because let's face it, the cost of things don't typically go down. No, right? So the cost of things typically go up. Um and no matter what the utilization is, right? At least in this realm, right? We're not we're not talking about, you know, six CD changers, right? Where yeah, the cost is gonna go down because nobody uses it anymore because there's other technology. There's no other technology that is going to replace healthcare, right? The need for healthcare. So the cost is going to continue to go up because there is literally no other way for it to go.

SPEAKER_03 16:20

Well, the other thing is there's no checks and balances on it, right? There's a famous Vox, I gotta find it. There's a famous Vox video where I don't know if you remember this, he's a Vox journalist, he's married, his wife is about to have a child, and he decided to do a social experiment where he called the insurance company. Yes, and he wanted to know what's the upcome upfront cost of this delivery.

SPEAKER_01 16:42

Yes.

SPEAKER_03 16:43

So there's there's literally no way for me to discover what the cost is until after I buy it. Is that right? Didn't I keep that information on hand? Everything is processed after. They couldn't give him a straightforward answer. Literally, they didn't even know who to send him to first.

SPEAKER_02 16:59

Yeah.

SPEAKER_03 16:59

So he tried going to an insurance company. They were like, We're sending you back to the hospital because it's all about how much the hospital is gonna charge us.

SPEAKER_02 17:07

Right.

SPEAKER_03 17:07

And then he started finding out, like, you know, the whole thing that we all learn about in med school that a Tylenol pill is what, a hundred dollars.

SPEAKER_01 17:15

You don't learn that in med school.

SPEAKER_03 17:16

I heard it in med school, though.

SPEAKER_01 17:17

You might have heard it, but we don't learn it.

SPEAKER_03 17:21

All right, you may be right.

SPEAKER_01 17:22

Okay, like they'll teach us no prices of anything in med school.

SPEAKER_03 17:26

Maybe right.

SPEAKER_01 17:27

Yeah, not maybe.

SPEAKER_03 17:28

So everything is inflated. Um, but he ended the video by like he just had to estimate.

Costs Shift To Patients And The ED

SPEAKER_01 17:34

Right. He had to just don't know. The you know, the only way to know what you're going to pay for a hospital say, like, let's say a delivery in a couple of days postpartum, is you have to look at other people who had similar, you know, situations as you and then see what they paid and then estimate on average how much that might be for you. That I think that's literally the only way to do it. Because they can't they they can't tell you. You're about to embark. Rem remember, and I think we learned this, we might have learned this when we were getting our MBAs, but healthcare is one of the only, if not the only industry where you consume something without ever knowing how much it's going to cost you up front. You you just don't know. So you have no clue what you're getting yourself into.

SPEAKER_03 18:33

You know, here in the United States.

SPEAKER_01 18:35

Here in the United States, well, that's yeah.

SPEAKER_03 18:36

Well, I mean, we're just we've been we've been to Ghana where before you get a medical procedure done, they can give you, they have an Excel document or they have tabulations that can tell you you need appendectomy, this is how much anesthesia is gonna cause, this is how much you know the surgical procedure is gonna cost, this is how much antibiotics is gonna cause, this is how all this is gonna cost. This is kind of sort of speak where you're gonna be at. Right. So I definitely think in other countries they're able to do it. Here in the United States, it's a huge conglomerate, it's a huge They either can't or they won't. Yeah, it's an inefficiency that people profit from, and as a result, the opacity of it benefits somebody and they're gonna make a lot of money from it. So it's not gonna get any clearer.

SPEAKER_01 19:13

Can you imagine going into the supermarket and not knowing what you're gonna pay? Which, by the way, Alfred, if you could just throw in that video that we're going to send you about Dr. Nee going to the supermarket to shop for Thanksgiving and knowing exactly what he's going to pay before we ever get to the register.

SPEAKER_02 19:37

What video was that?

SPEAKER_01 19:39

Just watch the video.

SPEAKER_02 19:40

Okay.

SPEAKER_03 19:41

That's what you're doing. Punching around this technologically advanced shopping cart. Not only can I pay for this, or excuse me, not only can I keep track of what I bought, but I could also get any coupons available for this. And I could pay for it, and I ain't gonna be on no damn line. This is the phone.com.

SPEAKER_01 20:05

Let's see you pick up an item and uh let's see how it works.

SPEAKER_02 20:10

Okay.

SPEAKER_01 20:11

So would you like some pie?

SPEAKER_00 20:14

Yeah.

SPEAKER_03 20:15

Let's do a family-sized pumpkin pie, right?

SPEAKER_00 20:17

Oh, you're gonna get canceled.

SPEAKER_01 20:19

Well, you might want to get sweet potatoes, bruh.

SPEAKER_02 20:22

Oh, okay. There's a difference. You're definitely canceled. Alright, so the sparkle's there. I just go. Sweet potato pie. Let's see. Sweet potato pie. Right there. What do you think about it? Oh, they got this type of shoot. That's dope actually. They got this shoe for that's cheaper. Okay, you might you you might be uncancelled. So we getting that? No, we're not getting that one. We're gonna get the other one. If I want to get rid of it. If you want to get rid of it, yeah.

SPEAKER_00 21:00

Oh, you just scanned it twice? No. Oh, okay. It's just gone. So it weighs it. It doesn't buy weight.

SPEAKER_03 21:07

No, this camera's here.

SPEAKER_00 21:09

Ah, the camera.

SPEAKER_03 21:11

And it has a barcode there. Yo, read the barcode. Okay. Are we getting this one?

SPEAKER_00 21:16

No, we're gonna get the bigger one from uh Costco?

SPEAKER_02 21:19

Yeah. Oh, now you know. That was fun. That was fun.

SPEAKER_03 21:24

That's dad life right there. Alright. So let's get let's get on let's get on my point two. Let's get on my point two. So point is point two is who gets hit the hardest. Um, as you already know, I talked about in the intro, it's gonna be patients, right? So they may either drop coverage because it's gonna cost too much, right? Um, which means they're gonna end up coming to the ED sicker. Um they're gonna be missing a whole bunch of appointments because all the things that were covered before, they ain't they ain't showing up. So they're gonna show up in your ED. So if you're a doctor in the ED, if you're a doctor in the ED and you drive a lucid, your day is about to get busier.

SPEAKER_01 21:59

Well, you leave that the love alone.

SPEAKER_03 22:00

Your day's about to get busier. You better charge longer. Like I'm about to have an easy day today. Fuck out of here. You better charge. You ain't leaving on your end of your shift. That's what's gonna happen. So listen, um, if you're a healthcare worker that's right. If you're a healthcare worker, um if you're a healthcare worker, you're gonna see your premiums ride, whether you're employed or not. They're going up, telling you it's right now. So um that's a problem. And then obviously, if you're an independent contractor, here's where one thing that got to think about. Those independent contractors who we this is what we suggest. Listen, if you got like three jobs, tree jobs, and you're like juggling them, they're gonna look at which one's gonna pay you them them the most and they're just gonna focus on that one. Okay, that's what I would do. Whichever one pays me the most, that's what I'm going to. Right. So all these other hospitals that are like, oh, we're really like relying on you to come, it's like, well, if you ain't paying like top dollar, I can't afford you. Yeah, you I you can't afford me.

SPEAKER_00 22:57

You can't afford me.

Why Prices Rise: Policy And Utilization

SPEAKER_03 22:59

Yeah, man. Yeah, yeah. This this this is um it's a problem, you know.

SPEAKER_01 23:04

Well, everybody's gonna end up paying more, right? I mean, what's gonna happen is the hospitals are gonna end up paying more because they're gonna have to pay you know, locums more. And that's granted, if doctors get on board and actually function like the businesses that they are, the independently contracted ones anyway. So they're they're the hospitals are going to just have to pay more. So I would I honestly encourage and urge doctors, especially the new docs out there, do your research. You know, the new docs who are doing locums, like even if you've been in the business for a while, you and you're new to locums, you're new to independent contracting. I I encourage you, do your research. Do not go out there taking$90 an hour, okay, when your premium is about to go up.

SPEAKER_03 23:58

I know why you're saying that because you don't because you don't want your pay to go down. That's true, though. That's me though. I don't want my pay to go down. Right, so I don't want my pay to go down. Just get more just get straight. Listen, y'all. The new docs out there, yo, stop taking these low ball prices, yo. You need to start negotiating more because what happens is you take the cheapest price, then you you mess with my money. All right. So it's not only you screwing yourself, but you're screwing me. Yeah. So now that prices are gonna go up, hey, the price yesterday is not the price today. Okay, all right? So negotiate more. Boom. There you go. Let's do some action steps. That was one action step right there. I like that. I like that. I like that. So listen, this is mainly for not the docs who are making like over six, six figures. Um, but I think for the docs who are in training right now, um, docs who are maybe in training and doing um they're doing uh locums, right? You can go to the website, whatever state you're in, you can check to see if you if you have subsidies, right? Whatever subsidies that you may be eligible for and they are still out there, sign up for them, right? For the most part, if you're making over like, you know, six figures, you're probably not gonna be eligible unless you have like an adjusted gross income which is related to how many tax deductions you got, dependence, things like that.

SPEAKER_01 25:10

Why do you tap on me when you said dependence?

SPEAKER_03 25:14

Because you don't work.

SPEAKER_01 25:16

What do you mean I don't work?

SPEAKER_03 25:18

You don't contribute. I don't I contribute. You don't listen.

SPEAKER_01 25:22

Okay, you know what? If that's the case, then I really am not gonna go to work.

SPEAKER_03 25:27

Okay, now I work. All right, listen. Um action step number two. This is for everybody. Listen, y'all need to start budgeting. That's what I'm telling y'all right now. If you know that, for example, for us that we're gonna be more than$300,$400 every month, you guys got to start considering that in your calculations of what you're spending on a monthly basis. Just keep that in mind, right? So that you're ready for these higher premiums. Don't forget also, there's gonna be higher out-of-pocket costs, also. So you may want to buff up those HSAs, right? The health spending accounts. You may want to buff up those um FSAs, the flexible spending accounts, also, because you're gonna be more of the responsibility of paying for your health care is gonna be on you. So you might as well just start planning for that, okay? Um, so you don't want to walk into this blindsided, you just, you know, someone is gonna have to pay the piper, it's gonna be you. So you just want to make sure you're saved up, right? One thing that I looked up that I didn't consider is this if you're an independent contractor listening right now, you can consider a change in your business structure. Check this out, right? You may want to consider a business structure that allows you to purchase coverage through a group plan, right? So not as an individual, but as a group plan, such as an LLC tax as an S-corp with at least one employee. So now you're buying a group plan, and it may just be you, but the reason why is that the price spike is really just for individual plans. That's what we're finding out. The price spike doesn't affect group plans right now.

SPEAKER_01 27:01

So this this is actual, these are healthcare plans.

SPEAKER_03 27:06

Correct. Correct. That's just some so but if you change your structure of your organization to be like we're gonna cover a group plan, you might be able to get a better benefit.

SPEAKER_01 27:15

I see.

Price Opacity And Broken Incentives

SPEAKER_03 27:16

Um for the employed physicians, listen, man. Um if the subsidies expire, just make sure, you know, there's gonna be changes in your covered drugs, there's gonna be premium increases, there's gonna be deductible increases. Um you need to call HR, find out what's the scoop. They can give you a heads up. Okay. And then the other thing, this is, and I think this goes a ways also, is you know, for those who are pretty conscious with their patients, is prepare your patients. Let them know. Let them know that, hey, um, you know, whether you are um, you know, if you have Medicaid or Medicare, depending on if you deal with those type of patients. Um if you have patients who have their own private insurance, or if you have people who are small business owners, things are gonna change and be prepared. And um, you know, get them ready to be like, hey, listen, like, you know, there's some options out there, you know.

SPEAKER_01 28:11

So it's I would say one other thing I would add to that is that there are now alternatives popping up.

SPEAKER_03 28:20

Oh yeah, you mentioned this. I f I keep forgetting about this, but yeah, go ahead.

SPEAKER_01 28:23

Yeah, there are there are healthcare insurance alternatives that are starting to pop up. Um and I don't know we should mention one in particular, but there's um one called Indie Pop. Um, but it it's like it's kind of like membership-based.

SPEAKER_03 28:42

They're not a sponsor, guys.

SPEAKER_01 28:43

No, they're not a sponsor. Um but they're they are kind of like a membership based. They, you know, I can't explain the whole thing um because I, you know, I don't know all the ins and outs, but people are using it um to essentially not necessarily purchase ACA plans, right? Or have your typical healthcare insurance. And people are using it for things like surgical procedures, office visits, urgent care visits. And apparently there isn't as much of the rigmarole of trying to figure out, you know, am I authorized? You know, do I have to get a referral? Do I have to do this? Do I have to do that? It's much more flexible.

SPEAKER_03 29:28

So it's it's it's more like it's more like a co-op.

SPEAKER_01 29:30

Yes.

SPEAKER_03 29:30

Right? So if you depending on which neighborhood you live in, if you live in a nice neighborhood, there might be a co-op in your neighborhood, which is in essence like a supermarket that everybody contributes to. The prices are a little bit uh more expensive, but you get, you know, the in essence, it's like going to Walmart or going to your local supermarket, but it's really more mom and pop. And the community benefits because you know they have their own type of supermarket.

SPEAKER_02 29:58

Yeah.

SPEAKER_03 29:58

As opposed to having a big box company come in. Now, what you're talking about specifically with with the co-op is you join a community and then all the monies that you guys put in gets rationed out to everybody within the community.

SPEAKER_02 30:12

Right.

SPEAKER_03 30:13

And what they end up finding out is that these co-ops, these communities, spend money better than if you went through an insurance company.

SPEAKER_01 30:21

Is that like a healthcare sussu?

SPEAKER_03 30:24

Uh for all the immigrants, for all the West Indians listening.

SPEAKER_01 30:29

You not like you know that susu life. You know that susu life.

SPEAKER_03 30:34

Explain what a susu is for those who ain't who ain't from the Caribbean, please.

SPEAKER_01 30:38

So a susu is essentially uh it's kind of like a savings uh quote unquote account. It's really not an account because it doesn't go in a bank. So you get like, let's say, five friends, six friends, however many friends you have, and then they all put money into what they call a susu. Usually one person is collecting the susu, right? And you all take turns essentially collecting the sussu such that as everybody collects, then it goes to one person, and then you rotate the next cycle, then all of the money goes to the next person, then you rotate the next cycle.

SPEAKER_03 31:17

When an issue happens, right?

SPEAKER_01 31:19

When well, it can be when an issue happens, or it can just be when the cycle completes.

SPEAKER_02 31:24

Okay, gotcha.

SPEAKER_01 31:25

Right. So after you've done six cycles, everyone should have gotten money from the sussu. But sometimes people be taking off with the susu, you know what I'm saying? You gotta be careful about the person who is like the first, the third, you know, the whatever. If they're not the last person in the sussu, they might just take off with it.

SPEAKER_03 31:50

So do you have any experience with susus then?

SPEAKER_01 31:52

No, I've never done a sustainable. Yeah, me neither. Specifically for that reason, because people be taking off with the susu.

SPEAKER_03 31:57

Well, I'll I'll I'll preempt it with this. Do you have you been at a job where they could have been a susu? I haven't been at one.

SPEAKER_01 32:03

Oh, yeah, I've been at jobs where they could have been a susu for sure.

SPEAKER_03 32:06

For sure. Yeah, the sports authority didn't have one.

SPEAKER_01 32:11

But that is a job that could have had a susu. You think so? Oh yeah. Oh yeah.

SPEAKER_03 32:15

Well, it depends on who's the demographic, who's the employees of the like susu is more of a West Indian type thing, right?

SPEAKER_01 32:21

Like West Indian thing. Yes, of course. So But I've definitely I've definitely been at jobs where there could have been a sussu.

SPEAKER_03 32:29

Well, look, uh, we beat this up uh a bit. So, guys, we're we're gonna go on to our next topic, all right? So um the next one, the next thing we're gonna talk about is a question from a listener listener, excuse me, um, who wants to talk about PSLF and being a first generation um immigrant as well as going into med school. We're gonna catch you guys on that next segment.