As 2025 draws to a close, millions of Americans enrolled in health insurance plans under the Affordable Care Act (ACA) are facing a daunting reality: their premiums are set to skyrocket. Without the enhanced subsidies that have been in place since the COVID-19 pandemic, many families, especially those with significant health challenges, will experience steep hikes in monthly premiums, potentially reaching into the thousands. These changes, which will hit on January 1, 2026, are part of the ongoing fallout from the expiration of temporary provisions introduced under the American Rescue Plan in 2021 and extended in the Inflation Reduction Act of 2022.
For some, these subsidy cuts mean choosing between paying for vital health insurance or cutting other essential expenses. For others, it may mean forgoing coverage altogether.
A Case Study: The Vincentys’ Struggle
Laurel Vincenty and her husband, Philip, both in their 60s and self-employed in North Carolina, are facing a sharp increase in their monthly premiums. Under the ACA, they currently pay about $400 per month in premiums, while an additional $1,700 is covered by subsidies. But come January, the Vincentys will lose those subsidies entirely, and their premiums are set to climb dramatically, putting their health insurance in jeopardy.
The Vincentys have already faced immense medical costs. Laurel was diagnosed with breast cancer in 2020, and in 2024, Philip suffered a heart attack. Their ongoing health issues have resulted in significant medical debt, much of which they are still working to pay off. Moreover, their monthly medications are expensive, further compounding their financial challenges.
To prepare for the higher premiums, Laurel took a second job this month, hoping it will be enough to offset the increase. However, she admits she’s unsure if it will be sufficient to cover the full extent of the rising costs. The couple’s situation highlights the dilemma faced by many Americans: the rising cost of health insurance is pushing people to the brink, forcing them to either cut back on essential services or face the reality of going uninsured.
“It was frustrating receiving the letter,” said Laurel, “knowing that we may lose our subsidies, and not knowing how we’ll be able to afford our health insurance.”
The ACA Subsidy Controversy
The expiration of these subsidies is a key point of contention in the ongoing political battle over government funding. The subsidies, initially introduced as part of the American Rescue Plan under President Biden, were designed to offer financial relief to Americans struggling with health insurance premiums during the pandemic. While these subsidies were set to expire at the end of 2022, they were extended through 2025 as part of the Inflation Reduction Act.
Now, as Congress grapples with the looming threat of a government shutdown, Democrats have demanded that these subsidies be extended further in exchange for their votes to reopen the government. Republicans, however, have pushed back, arguing that the subsidies are unsustainable and contribute to rising government spending.
As the debate continues, Americans like the Vincentys are left in a state of uncertainty, unsure if their healthcare costs will continue to rise or if a legislative solution will be reached in time to avoid further disruption to their coverage.
Rising Premiums Across the Country
The impact of the subsidy cuts is not limited to the Vincentys. Across the country, millions of people who rely on ACA coverage will face higher premiums in 2026. According to an analysis from the Kaiser Family Foundation (KFF), without the subsidies, the average out-of-pocket premium payments for ACA enrollees are expected to double, from $888 per year to $1,904. This increase is expected to have a devastating effect, as nearly 4 million people may be forced to drop their coverage entirely.
For some, the premium hikes will be steep enough to cause them to reconsider their insurance altogether. Take Jeff Feldman, a 60-year-old musician from Phoenix, who recently received a letter from HealthCare.gov indicating that his subsidies will no longer be available in 2026. Feldman, who currently pays $300 per month for his health insurance, estimates his premiums will triple to $900, while his $9,000 yearly deductible will remain unchanged.
“I can’t afford $900 a month,” Feldman said. “I have two jobs, and I’m going to start driving for Uber and Lyft just to get some extra money. But even with that, I can’t afford it. So, I’m going to go uninsured next year and save the money for potential emergencies.”
Feldman’s decision to forgo insurance and rely on savings in case of a medical emergency highlights a growing trend among ACA enrollees: with premiums rising, many individuals may opt to skip insurance altogether, potentially leaving them exposed to significant financial risk in the event of an unexpected health crisis.
Business Owners Feeling the Strain
For small business owners, the elimination of ACA subsidies could have devastating consequences. Wesley Hartman, a 40-something tech entrepreneur from Chatsworth, California, and his wife, both self-employed, recently received a letter informing them that their monthly premium would rise by $238, from $1,212 to $1,450. Though they can afford the increase, Hartman said the additional cost will mean sacrificing plans to expand his business.
“I won’t be able to expand my business more, or hire additional staff, or purchase the software that could help me grow,” Hartman said. “It feels like there’s nothing I can do about it. America is supposedly run by small businesses, but it feels like the system is stacked against us.”
For Hartman, the cost increase is a blow to his livelihood, adding financial pressure to an already uncertain economic environment. Small businesses like his are the backbone of the U.S. economy, and many entrepreneurs are struggling to balance their healthcare needs with the demands of growing their companies.
Navigating the Uncertainty
The expiration of these subsidies is set to affect more than 24 million Americans enrolled in ACA plans. As open enrollment for 2026 begins on November 1, these individuals will begin receiving notices about their premiums for the coming year. For some, the news will be a bitter pill to swallow.
Adrianna McIntyre, a health policy expert at Harvard University, explained that enrollees may have some options to lower their premiums by switching to a less expensive plan, such as from a silver-tier to a bronze-tier plan. However, this often comes with a significant trade-off: higher deductibles and out-of-pocket costs. McIntyre also noted that navigators, who typically help people explore their options on the ACA marketplace, have been severely underfunded since the Trump administration’s cuts to their budget in 2020, leaving many consumers without the support they need.
The consequences of these cuts could be severe, according to Lawrence Gostin, a public health expert at Georgetown University. “Even if a deal is done to extend the subsidies,” he said, “many enrollees will drop out due to the sticker shock.”
Conclusion
The expiration of ACA subsidies is more than just a policy issue—it’s a real, everyday concern for millions of Americans. As premiums rise and subsidies disappear, many individuals and families are left wondering how they will afford basic health insurance coverage. The situation underscores the urgency of reaching a political compromise that ensures affordable healthcare access for all, especially those who are already struggling with significant health challenges.
