Leighanne Safford and her husband Lorry pay health insurance just $278 a month. However, starting January 1st, the monthly premium could jump to $1,800.
The Safford family is one of the millions who will be forced to pay hundreds of dollars in health insurance premiums next year as Affordable Care Act subsidies expired at the end of December.
Enhanced grants were introduced under the 2021 American Rescue Plan, making the ACA plan affordable for many middle-class families. The 2022 Inflation Reduction Act extended subsidies until 2025.
However, Republican-controlled Congress has not extended its grants on any of the two major funding bills passed so far this year. It is unclear whether Republicans will expand them to the bill to maintain funding for the government by September 30th.
For Safford, its effectiveness could be worsened by a rollback to the spread of Medicaid in President Donald Trump’s vast legislative bill signed into law over the summer. She fears that her 13-year-old son, Adam, could lose Medicaid coverage, so the family plans to pay for health insurance in 2026.
Safford said he can’t afford a monthly premium of $1,800 without cutting back on essentials such as food and dental care. Instead, they are trying to switch to a cheaper, more advanced deductible plan that covers the entire family. Trade-offs: While monthly premiums are usually lower, you will need to take on higher out-of-pocket costs before coverage begins.
“Now we are making decisions based on three people who are relatively healthy,” Safford said. “But as we all know, with health, that can change at any time.”
More than 24 million people have health insurance through the Affordable Care Act of 2025, according to data from the Health Policy Research Group KFF. Of these, more than nine out of 10-22.3 million people were eligible for the enhanced subsidies. (The figures also include eligibility for the ACA standard subsidy for very low incomes that came into effect in 2014 and are expected to continue.)
At least 96% of ACA enrollees received increased subsidies in Mississippi, Florida, West Virginia, Oklahoma, Louisiana, Utah and Alabama. New Hampshire and Washington had the lowest rates at 71% and 73%, respectively.
If the strengthened subsidies expire, a 2024 analysis by the Congressional Budget Office, a nonpartisan body that advises Congress on budget and economic issues, predicts that around 4 million people will not be able to pay premiums in 2026. That number is expected to rise to around 7 million by 2034.
If Congress doesn’t act, “millions of people will be uninsured,” says Edwin Park, a research professor at the McCourt School of Public Policy, Georgetown University. “Without these grants, it would be much more expensive.”
Double Wrmmy
Open registration for next year’s ACA plan will begin on November 1st.
However, for many families, the “sticker shock” is expected to arrive in October. In October, official notifications will land in your mailbox, which outlines your monthly premiums for next year, said Jessica Altman, executive director of Coverd California, the state-based market for ACA coverage.
“There’s a lot of fear,” she said. “Whether it’s someone with cancer, or someone with a chronic condition who knows they need it, or someone who thinks, ‘I might just have to go with my fingers and just cross my fingers’.”
In Sacramento County, the four families who earn $113,000 a year could see an increase in monthly premium jumps by about $1,550 if government subsidies expire, compared to just $112 if subsidies remain.
In addition to expired subsidies, the state must consider the expected premium hike from insurance companies next year.
It’s “a double wamy of rising premiums and could lower tax credits,” Altman said. A report from KFF found that insurers offering ACA plans are planning an average premium increase of around 18% across the US in 2026. According to KFF, people could increase by 75% on premiums on average.
Cynthia Cox, vice president and director of KFF’s ACA program, said people still qualify for standard ACA grants. Without strengthening subsidies, the amount the government pays for monthly premiums will be reduced.
“The effect will be quite broad,” Cox said. “This will affect almost everyone who purchases their health insurance in some way.”
At a Safford home in Washington, Dr. David Zoney said many of his patients would be directly affected. Zonies is a safety net hospital that is medical director at the University of Washington Harborview Medical Center, and mostly cares for Medicaid and ACA patients.
The increased subsidy loss, along with Medicaid reductions, means that many patients become uninsured, delaying the care they need until it becomes much more serious, he said.
“The biggest concern I have right now is the loss of these tax credits,” Zony said. “We basically expect to go back to what it looks like before the Affordable Care Act is passed, and that’s going to be really devastating.”
A spokesman for AHIP, a leading industry trade group representing insurance companies, including those selling ACA plans, did not respond to requests for comment.
The fight to expand subsidies
Park said Congress could potentially extend the strengthened grants, either as part of the government’s funding package or as another bill. The latest government spending bill will expire on September 30th.
“It’s very difficult to predict,” he said.
Democrats continued to advocate for expanding subsidies, and many Republicans remained opposed.
But Senate majority leader John Tune (Rs.D.) told NBC News earlier this month that he was leaving the door open for potential extensions.
“Yeah, that’s something some of our members are paying attention,” Thune said, but he blamed Democrats for expanding the program and including a gradual out-of-grant.
House speaker Mike Johnson, R-La. was not a commitment on this issue, but he similarly left the door open to extensions of funding.
Altman said Congress needs to know what they want to do quickly, and said the expansion would not only provide “safety” for many families, but also provide the safety of healthcare and economic freedom.
A June report from KFF found that three in four adults were in support of expanding the expansion subsidy, including two-thirds of Republicans.
Park said the enhanced grants passed by Republicans may not be the same as Democrats had previously done.
“If there is a willingness to negotiate an extension of the enhanced credit, I hope they may seek to reduce the generosity of the enhanced subsidies,” he said.
Cox said some families may decide to maintain compensation by making sacrifices to their household, but it is likely that most people, like Safford’s families, will move to deductible plans. People in these plans will have to pay from more pockets before coverage begins, but this plan is designed to protect against huge financially devastating healthcare costs.
“Suppose you’re hit by a bus and you’re receiving cancer and the very expensive treatment you need. Such a plan would evacuate you from the very high hospital costs,” Cox said.
Safford said it continues to “knock on the tree” on the extension of the grant.
“It’s going to leave our lives,” she said, if they don’t expand, it’s going to take it from our lives.”
