Leslie Smith, a 64-year-old Arizona resident living with diabetes, is one of the millions of Americans racing against the clock to secure health insurance coverage for 2026. With a deadline approaching on December 15, Smith and many others are grappling with the impending expiration of COVID-era subsidies designed to make Affordable Care Act (ACA) premiums more manageable.
Despite the financial constraints, Smith has faced a dilemma over her plan selection as Congress debated the continuation of these subsidies that have greatly benefited around 22 million Americans. On December 12, the Senate rejected a proposal put forth by Democrats to extend these subsidies, leading to fears of sharply rising costs starting January 1, 2026. Without the enhanced premium tax credits, consumers like Smith can expect substantial increases in their health insurance expenses.
In tandem with this, House Republicans have introduced a legislative proposal aimed at healthcare affordability that does not include an extension of the ACA’s premium subsidies. A vote in the House is anticipated within the week, but the timeline is tight for current enrollees hoping to secure affordable coverage.
ACA enrollees must finalize their insurance choices by the rapidly approaching Monday deadline. Experts expect many will reassess their budgets, especially considering the impending expiration of the enhanced tax credits. “People have to make these big financial and health decisions, and they are making them right now,” said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.
According to a recent survey conducted by KFF, nearly one in three ACA enrollees may consider switching to a new health insurance plan if their premiums double. In fact, many consumers are likely taking active steps to evaluate their options amid increasing costs.
For Smith, choosing a plan has never been more complicated. Since her diabetes diagnosis in her 20s, she has prioritized robust and affordable health insurance, guiding her decisions when switching jobs. Following her retirement five years ago, she has relied on ACA insurance—yet now faces a staggering monthly premium that could climb to $948, representing a $368 increase. This financial strain has led her to contemplate downgrading to a less expensive plan until she becomes eligible for Medicare mid-2026.
However, less expensive plans may not provide the same comprehensive coverage, meaning she could incur higher out-of-pocket costs, potentially delaying critical medical procedures such as a much-needed knee replacement. “It’s very frustrating to me,” Smith expressed, adding that despite her careful planning and adherence to the system, she feels at a loss.
The push against extending the enhanced tax credits was notable, with Republicans initially resisting inclusion in the federal budget. This political maneuvering catalyzed a record 43-day federal government shutdown, only to be resolved when Senate Republicans assured a vote on the tax credit extension. Ultimately, four Republicans sided with the Democrats, yet the proposal still fell short of the necessary support to pass.
As the deadline looms, consumers are advised to assess their health insurance options actively. This includes logging into ACA accounts to evaluate both their current plans and any potential switch to lower-cost bronze plans. The expiration of the enhanced tax credits is projected to lead to an average 114% increase in monthly premiums for affected Americans.
A concerning KFF survey indicates that one in four ACA consumers may consider dropping their coverage should costs more than double. Many are prepared to sacrifice daily spending, take out loans, or increase credit card debt in order to manage the rising health care costs.
This surge in insurance premiums is not limited to ACA customers; most working-age Americans, who obtain insurance through their employers, are also projected to face substantial increases—potentially the largest since 2010. Advocacy groups are voicing serious concerns about the potential rise in the uninsured population, especially in states like Florida, where over 4 million residents depend on subsidies for affordable healthcare. Health policy analysts warn that without these financial aids, families could face crippling financial burdens—or worse, go without coverage entirely.
