Late last month, Elizabeth Wick received an email from her insurer, Blue Cross and Blue Shield of Texas, that brought her fears to fruition: her monthly premiums for an Affordable Care Act (ACA) policy would jump to $1,380 next year, a staggering increase from her current rate of $862. At 57, Wick, who operates a private therapy practice in Arlington focused on sexual assault survivors, relies heavily on these ACA health benefits due to her preexisting medical conditions. Currently receiving $400 in federal premium subsidies, she is uncertain about her eligibility for assistance in 2026 if the enhanced subsidies expire as scheduled at the end of the year.
This looming financial burden not only threatens her affordability of health insurance but also jeopardizes her ability to continue her practice. “Health insurance will determine what my life will look like, whether or not I can continue with my private practice,” Wick explained, sharing her anxiety over the matter’s impact on her life and work.
Wick’s plight is echoed by millions of Americans grappling with increased ACA premiums and potential loss of subsidies. Many enrollees may have to navigate painful trade-offs, including scaling back on everyday necessities or even forsaking health insurance altogether. The intensifying healthcare crisis is a significant factor in ongoing gridlock on Capitol Hill, where Democrats insist on extending enhanced subsidies as part of any federal funding package for fiscal year 2026, while Republicans maintain they will only negotiate after resolving the current government shutdown.
The enhanced subsidies, introduced during the pandemic in 2021, have allowed many lower-income Americans to access healthcare coverage with minimal or no monthly premiums. Even those in the middle class benefited from expanded eligibility. As a result, this year saw a record high of 24 million Americans signing up for ACA policies, largely aided by the enhanced subsidies. More than 90% of policyholders rely on some form of financial assistance.
However, the expiration of these enhanced subsidies, alongside rising healthcare costs, has caused insurers to hike rates an average of 26% for the coming year. Data from KFF, a nonpartisan health policy research group, indicates that even higher premiums loom for many enrollees, with average payments more than doubling. Those whose incomes hover just above the poverty line could witness their premiums leap from paying almost nothing to several hundred dollars annually—a significant financial shock for nearly half of all enrollees, according to KFF’s director of the Program on the ACA, Cynthia Cox.
Sunni Montgomery, 63, is currently battling lung cancer and finds herself in a dire situation as well. Relying on her ACA plan to cover ever-increasing medical expenses, she experienced a manageable premium of $541 this year thanks to subsidies. Next year, however, she anticipates her premium soaring to $1,758, a considerable burden that may lead her to become uninsured during a critical stage of her treatment. “I have to face the reality that I am probably going to become a late-stage cancer patient who’s uninsured,” Montgomery lamented.
The distress caused by rising premiums and expiring subsidies is not confined to the elderly or those with chronic illness. Chris and Donna Vetter, both in their 60s and residing in rural Maryland, face a similar upheaval; their monthly premiums are set to leap to $1,975—nearly half of their income. Despite pouring over ACA marketplace options, even the most affordable plans were near $1,000, leaving them compelled to drop their health insurance altogether.
For Alison and her husband in Carson City, Nevada, the decision about their ACA coverage is equally agonizing. With premiums expected to rise significantly, they are considering a switch to a less expensive — but higher deductible — plan, forcing them to think critically about doctor visits and urgent care needs.
Younger Americans also find themselves grappling with the daunting prospect of increased healthcare costs. Kris McKegney, a 23-year-old self-employed accountant, faces a drastic rise in premiums that could push him to either catastrophic plans or policies with such high deductibles that they effectively function as no coverage at all. The political discourse surrounding the enhanced subsidies leaves him feeling “degraded,” underscoring the emotional and psychological impacts involved.
Newly engaged couple Nolan LeRoux and Emily Clute of Bethlehem, New York, have been considering postponing their marriage license just to navigate the complex subsidy implications. Increased premiums as a married couple could cost them significantly more each month, potentially altering plans for a honeymoon.
As these stories illustrate, the future of healthcare coverage for many Americans hangs in a delicate balance, influenced by legislative negotiations and broader economic trends. The specter of soaring premiums and diminishing subsidies casts a long shadow over the lives of those reliant on the Affordable Care Act, elevating anxiety about health and financial stability across the nation.
