Leighanne Safford and her husband Lorry pay only $ 278 a month for health insurance. But from January 1, their monthly bonus could drop to $ 1,800.
Safford’s family is one of the millions that may be forced to pay hundreds of dollars more for their health insurance premiums next year, while improved subsidies of the affordable care law expires at the end of December.
Improved subsidies have been set up as part of the 2021 American rescue plan, which made the ACA plans affordable for many families in the middle class. The law on the reduction in inflation of 2022 extended the subsidies until 2025.
The congress under republican control, however, did not extend the subsidies in one or the other of the two main financing bills adopted so far this year. It is not certain that the Republicans will extend them later this month in a bill to maintain the funded government.
For Safford, the effect could be aggravated by declines for the expansion of Medicaid in the Tripacer Legislative Bill of President Donald Trump signed during the summer. She fears that her 13 -year -old son Adam can lose his coverage Medicaid, so the family also plans to pay his health insurance in 2026.
Safford said they could not afford the monthly bonus of $ 1,800 – which only takes into account coverage for her and her husband – without reducing essential elements such as food or dental care. Instead, they seek to move to a cheaper and high plan that will cover the whole family. Compromise: Although monthly bonuses are generally lower, they should assume higher direct costs before the coverage is playing.
“Right now, we are making a decision based on the fact that the three of us are relatively healthy,” said Safford. “But I mean, as we all know, with health, it could change any day.”
More than 24 million people have obtained their health insurance thanks to the affordable care law in 2025, according to data from the KFF health policies research group. Among these, more than 9 out of 10 – 22.3 million people – qualified for improved subsidies. (This figure includes people who are also eligible for the ACA’s standard subsidies for very low income, who entered into force in 2014 and who should continue.)
In Mississippi, Florida, Virginia-Western, Oklahoma, Louisiana, Utah and Alabama, at least 96% of ACA registrants received improved subsidies. New Hampshire and Washington condition had the lowest rates, 71% and 73% respectively.
If improved subsidies expire, nearly 4 million people should do without coverage in 2026 because they will not be able to afford premiums, according to an analysis in 2024 of the Congressional Budget Office, the non -partisan agency which advises the Congress on the Budget and Economic Questions. This number should travel nearly 7 million people by 2034.
If the Congress does not act, “millions of people will not be assured,” said Edwin Park, research professor at the Georgetown University McCourt School of Public Policy. “Without these subsidies, it will be much more expensive.”
A double blow
The registration open for the ACA plans of next year begins on November 1.
But for many families, the “sticker shock” will come in October, when formal opinions will land in their mailboxes describing the monthly premiums of next year, said Jessica Altman, executive director of Covered California, a state market for the coverage of the ACA.
“There is a lot of fear,” she said. “Whether it is someone who has cancer or a chronic condition who knows that he needs it, or someone who thinks:” I may have to do without and cross my fingers. “”
In the County of Sacramento, Altman said that for example, a family of four people earning $ 113,000 per year could see its monthly premium jump by about $ 1,550 if government grants expire, against only $ 112 if subsidies remain.
In addition to expired subsidies, states must also take into account the bonuse increases expected from insurers next year.
It is “a double blow of bonuses that increases, then the tax credits are potentially lowered,” said Altman. A KFF report revealed that insurers who offer ACA plans provide an average increase in bonuses of around 18% in the United States for 2026. Combined with loss of subsidies, people could pay an average of 75% more in bonuses, according to KFF.
People who are still eligible for ACA’s standard subsidies will not be spared either, said Cynthia Cox, vice-president and director of the ACA in KFF. Without improved subsidies, the amount that the government pays towards their monthly premiums will shrink.
“The effects will be quite widespread,” said Cox. “Almost all those who buy their own health insurance will be affected by this way or another.”
In Safford’s house in Washington’s state, Dr. David Zonies said many of his patients will be directly affected. Zonies is the medical director of the Harborview Medical Center of the University of Washington, a safety security hospital which largely deals with patients in Medicaid and the ACA.
The loss of improved subsidies, as well as the Medicaid cuts, mean that many patients will not be assured and will delay the care they need until it becomes much more serious, he said.
“The biggest concern I have at the moment is the loss of these tax credits,” said Zonies. “We plan that we will essentially come back to what it looked like before the affordable care law is adopted, and it will be really devastating.”
An AHIP spokesperson, the main commercial group of the industry that represents insurers, including those who sell ACA plans, did not respond to a request for comments.
A struggle to prolong subsidies
Park said it was always possible that Congress could extend improved subsidies – either within the framework of a government funding package, or a separate bill. The last bill on public spending expires on September 30.
“It is very difficult to predict,” he said.
The Democrats continued to plead to prolong the subsidies and many Republicans remained opposite.
But the head of the majority of the Senate, John Thune, RS.D., told NBC News earlier this month that he kept the door open to a potential extension.
“This is something to whom, yes, some of our members pay attention,” said Thune, although he blamed Democrats to broaden the size of the program and including eliminations for subsidies.
The president of the Mike Johnson room, R-La., Was not engaged on the issue, but he also kept the door open to an extension of funding.
Altman said that Congress must understand what it wants to do quickly, noting an extension would not only provide “peace of mind” to many families, but also security in their health care and their economic freedom.
A June report from KFF reveals that 3 out of 4 adults support the extension of improved subsidies, including two thirds of the Republicans.
Park said that the improved subsidies adopted by the Republicans, however, are not the same as what the Democrats had previously had.
“I expect there to be a republican will of the congress to negotiate an extension of improved credits, they can seek to reduce the generosity of improved subsidies,” he said.
COX said that some families could decide to keep their coverage by making sacrifices to their household budgets, but most of them, like Safford’s family, will likely go to high plans. While people on these plans have to pay more about their pocket before the coverage puts themselves into play, the plans are designed to protect themselves from the huge medical invoices which can be financially devastating.
“Let’s say that you end up getting hit by a bus, you get a really expensive cancer or medical treatment you need. This kind of plan would house these very high hospital costs,” Cox said.
Safford said that she continued to “hit the wood” that subsidies will be extended.
“It would take away our life” if they are not extended, she said.
