CEDAR HILLS, Utah County — Brick Williams can be found criss-crossing northern Utah County to teach guitar, sometimes working until well after dark most nights of the week.
He caters primarily to students, so his day often starts when school lets out. With an average of 55 to 60 students at any time, that means he typically teaches “until around 10 o’clock every night.”
“It’s definitely a full-time job and keeps me busy, but I enjoy it. I really like the job,” he said, even if he admits “the hours of it are kind of rough.”
The 48-year-old Cedar Hills resident has been teaching guitar for 24 years, since graduating with a degree in music theory from what is now Utah Valley University. He is the founder and sole employee at Brick Williams Guitar, Inc., where he also teaches bass guitar and ukulele.
Though he doesn’t advertise much and relies on word of mouth, he has built a solid “middle-class” lifestyle for his family. His wife, Lisa, works part-time and takes care of their three daughters, the oldest of whom just turned 16.
Starting a small business is no small task for anyone, and Williams initially struggled to meet the high costs of health insurance premiums. Many Americans receive health insurance benefits from their employers, but as a self-employed individual, Williams was on the hook.
And his costs were far from typical.
At 19, he was diagnosed with common variable immunodeficiency, or CVID, an immune disorder where low antibody levels lead to frequent infections. It’s not uncommon for people to be diagnosed in their early adult years, but Williams recalled being “so unbelievably sick as a child and teenager” with illnesses that were likely the result of the disorder.
Williams has relied on twice-monthly infusions of blood plasma to bolster his immune system, but the treatments are costly, and the disorder initially made it difficult to stay on insurance because it qualified as a pre-existing condition.
The plasma infusions aren’t optional for Williams, who said: “If I didn’t get these treatments, I would likely not live very long or be horribly sick.”
“We were renting, and it would be close to the cost of rent, a month just for me to have insurance,” he recalled, “so, it was devastating to us financially.”
That changed in 2010 with the passage of the Affordable Care Act, also known as the ACA or Obamacare, which allowed self-employed people like Williams to purchase health care insurance through the state-administered marketplace and prevented providers from denying coverage based on pre-existing conditions.
The Affordable Care Act also provided federal subsidies to help Americans making up to 400% of the poverty level cover portions of their insurance premiums. Democrats in the Biden era eliminated the 400% income cap, meaning Americans with higher incomes could still receive some subsidies based on their annual income.
For Williams, that has meant not having to worry about falling off a “benefits cliff” if he earns $1 more than the income cap. But those enhanced subsidies are set to expire at the end of the year, meaning Williams and millions of other Americans could see their premiums increase by more than $1,000 a month — or a five- to six-fold increase in some cases.
Premium payments are expected to more than double on average for those currently receiving enhanced premium tax credits, according to KFF. The health policy nonprofit, formerly known as the Kaiser Family Foundation, has an online tool for insurance buyers to estimate their costs if the credits expire.
“It’s going to cost me more than my mortgage,” Williams said. “As a middle-class family, you can’t survive financially when you’re paying more than a mortgage for your insurance. That’s not a survivable thing.”
Holding the government ‘hostage’?
Those expiring subsidies are now at the center of congressional Democrats’ demands amid what could soon be the longest federal government shutdown on record, but Republicans, including those representing Utah, say the minority party is holding Congress “hostage” over the expanded subsidies Democrats themselves set an end date for.
Several Utah representatives said they were open to discussing an extension of the premium subsidies or other changes to Obamacare, but said the issue should be separate from the current shutdown fight.
“There’s a willingness on Republicans to look big picture at some of these issues that the Democrats want to discuss, like the ACA subsidies, but ... that’s not even a part of the appropriations process, so you can’t really negotiate the two with each other,” Utah Rep. Blake Moore told reporters on a call earlier this month.
Sen. John Curtis said the enhanced subsidies, enacted during the COVID-19 pandemic, were “temporary” when they were put in place and “now all of a sudden, it’s Republicans’ fault, right, that they’re expiring? ... That’s why I say it’s a kind of a half truth. They put the expiration date on there.”
“Now they’ve told us, ‘Sure, we’ll negotiate, but it’s all or nothing,” the Republican senator told reporters at his annual Conservative Climate Summit on Oct. 17. “That’s not a negotiation. A lot of Republicans are very sympathetic to increasing premiums. Would love to have a conversation about that. ... I don’t think anybody can look you in the eye and say you should have zero premium if you’re 400% of poverty. It’s not the best thing.”
Rep. Mike Kennedy said he’s “open to that conversation,” in an interview with KSL.com earlier this month, but said “to hold the government hostage, and its people hostage, to try to force a certain policy outcome is, I think, entirely inappropriate.”
Not everyone is so open to the debate. Utah Sen. Mike Lee, who was first elected during the Tea Party wave in 2010, suggested the Affordable Care Act be entirely repealed, something congressional Republicans tried and failed to do during President Donald Trump’s first term.
“Healthcare will keep getting more expensive until we repeal Obamacare,” he posted on X on Oct. 8, one week into the shutdown. “So Congress should repeal Obamacare. Republicans ran on this for a decade. We shouldn’t run from it now. Pass this on if you agree.”
Fighting fraud
The Affordable Care Act is not without its problems, as even its proponents will admit. A Florida executive pleaded guilty in April “for his role in a scheme to submit fraudulent applications to enroll consumers” in health care plans, according to the Department of Justice.
“We can imagine that when bundles of money are being put into certain programs, there’s always some not good person out there that is going to try to manipulate the program to their advantage,” Kennedy said. He added that much of the funding is “subsidizing individuals that do not need these subsidies.”
According to his office, some 1.7 million Americans who earn over 400% of the federal poverty line were eligible for a subsidy in 2024. Nearly 400,000 Utahns received the enhanced premium tax credits with an average credit of $463, though it’s unclear how many of those earn more than the 400% threshold.
One solution to the fraud potential, according to Herriman-based insurance broker Rylee McDonald, would be to eliminate no-fee insurance plans, which some low-income Americans are eligible for. Because the patients don’t pay any monthly premiums, he said some brokers have been able to enroll patients in fraudulent plans, misrepresent their income as below the threshold to make them eligible for a premium-free plan and collect the commission.
McDonald said he has had clients “stolen” by bad actors, and they didn’t even realize they’d been enrolled in a plan. But he doesn’t believe the issue to be rampant.
“It was enough that it created this whole drama of news cycle, because you had thousands of people being enrolled in free ACA plans without their knowledge or consent, and now they are on the hook for the tax repercussions of that if their income is higher than the (amount) that agent erroneously put into their application,” he said.
Premiums wouldn’t need to be high for these plans — “literally any dollar amount other than zero” — to prevent people from being enrolled in plans without their knowledge, he said.
Kennedy said this example is why he thinks there needs to be more public debate on the issue.
“What you’re describing is a good example of the kind of conversations that we should have in committee hearings,” he said. “That’s exactly why we shouldn’t do this in a smoke-filled back room.”
Health care vs. insurance
Kennedy has a unique perspective on health care policy as a trained physician who worked in primary care prior to his election. He said he has seen his patients get “less access to care” since the implementation of the Affordable Care Act, and said the broad policy debates incorrectly conflate health insurance with health care, losing sight of what patients actually need.
“Health care is not insurance. Access to health care — the insurance can facilitate that. The health care is so many things outside of access to insurance,” he said. “My point behind that is, yes, people should have access to health care. And the funny thing about that is, I saw people regularly that didn’t have insurance, and they got a significant discount.”
In some cases, Kennedy said insurance was more of a hindrance to receiving care, as patients suddenly couldn’t access medication for various maladies because their insurance “has a bargain deal with some other supposedly bio-equivalent medicine that’s cheaper for the insurance, but tips my patient over into a health crisis.”
That lack of preventative care can sometimes spiral and result in a costly visit to the emergency room that could have been prevented, he said.
“It’s penny-wise and pound-foolish with some of these decisions that are made outside of the doctor’s office,” he said.
What’s next?
With open enrollment looming, McDonald has said he would advise clients who are on the cusp of losing premium tax credits to “try to take a lower-paying job, take time off of work, whatever you’ve got to do,” because hitting the 400% income cap would be more costly.
For Williams, that would mean taking fewer clients or charging less. He and his wife have also discussed the potential for her to take a full-time job with benefits, but that would leave the couple searching for child care solutions.
“It incentivizes not thriving in your job or in your career because the less you make, the better off you are,” Williams said. “I’ve been successful to whatever degree, and I’ve been doing it for 24 years, and it puts a roof over my family’s head and food on our table. And I would like that business to be able to grow, and I’d like to be able to have it thrive, but if me working less helps me get better insurance — something seems wrong with that.”
He is aware of the perceptions some may have of people who benefit from federal subsidies, but said he has worked hard for 24 years and is “not looking for a government handout.”
“I’m looking for help because I have to have affordable health insurance to stay on the planet,” he said.
Lisa Williams said she can’t even quantify how beneficial the Affordable Care Act and the recent subsidies have been, because for her husband, it has meant “actual survival.”
Kennedy represents the Williams in Utah’s 3rd Congressional District, and when told of Brick Williams’ plight, he sounded sympathetic.
“Some people, if they make just that much more money, it’s not just health insurance,” he said. “They go off food stamp assistance. They can’t access (the Special Supplemental Nutrition Program for Women, Infants and Children) anymore. So they’re actually working part-time instead of full-time, so they keep other benefits. We should actually not drop people off of a cliff. If somebody is productive and you’re making 401% of the poverty level — which is just a number that we picked, 400% — should we take that guy off of any support at all? That doesn’t make sense to me.”
Just as senseless, however, in Kennedy’s eyes, would be to let a family with a high income receive subsidies.
“Between those two, there’s ways to make that work,” he said.
With the benefit cliff looming ahead of the December deadline to enroll in a plan to receive coverage at the beginning of next year, Brick Williams said he is “at the mercy of people being able to work these things out in a reasonable manner.”
“It’s going to take a bipartisan effort to keep the Affordable Care Act intact the way that it is,” Lisa Williams said. “I feel like I don’t see our state representatives, nor any representatives from other states, willing to work together to find solutions. They seem much more anxious to just stay battling each other for whatever ideological reasons they have, which I cannot begin to imagine.”