Residents in Massachusetts who obtain their health insurance through the Massachusetts Health Connector are bracing for significant premium increases in 2026 if Congress fails to extend key subsidies amid ongoing government funding negotiations.
With open enrollment set to begin on November 1, it is anticipated that tens of thousands of individuals may lose some or all of their financial assistance. The enhanced premium tax credits, introduced under the Inflation Reduction Act of 2022, are scheduled to expire at the end of this year. Additionally, the One Big Beautiful Bill Act is projected to create further disruptions in healthcare coverage.
As the U.S. government remains shut down, following Congress’s inability to pass stopgap funding measures, Senate Democrats are resisting any compromises that might hinder the continuation of enhanced tax credits that first became available during the COVID-19 pandemic.
According to information provided by the Health Connector, while many individuals will still qualify for some form of financial assistance, the support will be significantly diminished. Starting January 1, those households earning above 400% of the federal poverty level—about $62,600 for an individual or $128,400 for a family of four—will lose access to highly subsidized ConnectorCare plans. Instead, they will be directed to explore unsubsidized health plan options, which could lead to increased out-of-pocket expenses.
If these credits lapse, it is estimated that approximately 65,000 residents—an amount large enough to fill Gillette Stadium—might lose their coverage over the coming 14 months, with hundreds of thousands more likely to see their healthcare costs rise, making access to necessary services increasingly difficult.
Audrey Morse Gasteier, Executive Director of the Health Connector, emphasized that members could start viewing their premium hikes on their online portals in the coming weeks, with physical notifications expected to arrive soon. She noted that many members have enjoyed substantial financial support through tax credits in the past year and will soon face stark increases without that assistance.
Those who earn between 300% and 400% of the federal poverty level will still have access to subsidized care through the end of 2026, but many others will be immediately affected by the impending changes.
Vice President JD Vance has called out inefficiencies, asserting that the current tax credits contribute to waste in the insurance sector. Senate Majority Leader John Thune has discussed potential deals with Democrats to extend tax credits with included reforms, but as of Thursday, Senate Democrats rejected a stopgap spending bill for the tenth time, aiming to secure preservation of the tax credits.
The enhanced premium tax credits have played a significant role in driving enrollment in the Affordable Care Act Marketplace, increasing from around 11 million to over 24 million participants since their introduction.
At a recent press conference, Dr. Manju Mahajan shared a concerning story about a 52-year-old single mother who relies on tax credits to afford her premiums. Currently paying $75 a month, she faces a potential increase to $500, which may force her to drop her health coverage entirely. This could lead to severe health consequences due to the inability to access preventive services and medications.
The Health Connector has highlighted examples of how premium costs could skyrocket. For instance, a hypothetical couple in Peabody earning $85,000 could see their monthly premium leap from $892 to nearly $2,100. Similarly, a couple in Worcester could see their premium increase from $528 to over $1,600.
Concerns are mounting among healthcare leaders about the repercussions of eliminating these subsidies. Valerie Fleishman, executive vice president and chief innovation officer at the Massachusetts Health and Hospital Association, stated that discontinuing tax credits would be detrimental to both patients and the strained healthcare system.
A recent $2.25 billion spending bill passed by the Massachusetts House aims to rework the hospital assessment program and bolster the Health Safety Net Fund to support uninsured and underinsured care. However, the looming loss of coverage could exacerbate existing strain on healthcare resources, pushing hospitals into a deeper financial crisis as they absorb unpaid care.
Health Connector staff are preparing for an influx of inquiries as residents begin to learn of impending premium increases, highlighting the emotional and financial distress that many will experience as they navigate these changes in their healthcare coverage.
