Leighanne Safford and her husband, Lorry, currently pay just $278 a month for health insurance. But starting January 1, their premium could skyrocket to as much as $1,800. This massive increase isn’t just a personal issue; it affects millions of families across the U.S. as enhanced Affordable Care Act (ACA) subsidies are set to expire at the end of December.
These enhanced subsidies were introduced in 2021 through the American Rescue Plan, making health insurance affordable for many middle-class families. Although the Inflation Reduction Act of 2022 extended these subsidies until 2025, Congress hasn’t moved to prolong them in recent funding bills. It’s unclear if they’ll take action by the September 30 deadline.
For families like the Saffords, the situation is dire. Leighanne fears her 13-year-old son, Adam, may lose his Medicaid coverage due to cuts in Medicaid expansion legislation signed in the summer. This uncertainty is forcing them to consider purchasing private insurance plans, which can be a financial gamble.
“Right now, we feel okay since we’re healthy,” Leighanne said. “But we know health can change in an instant.”
Recent data shows that over 24 million people rely on ACA plans, and an alarming 22.3 million of them—more than 90%—received enhanced subsidies. In some states like Mississippi and Florida, nearly all enrollees benefited from these subsidies. However, if they expire, nearly 4 million people could find themselves without coverage in 2026, with the number potentially reaching 7 million by 2034, according to a 2024 Congressional Budget Office analysis.
Edwin Park, a research professor at Georgetown University, emphasizes the stakes. “Without these subsidies, millions could become uninsured,” he said. He added that the health care landscape would regress to pre-ACA conditions, which could be devastating for many families.
Open enrollment for the next ACA plans kicks off on November 1. However, many families will feel the “sticker shock” earlier, when their new premium notices arrive in October. Jessica Altman, executive director of Covered California, notes that the emotional toll is significant. Families are facing anxiety, especially those relying on their coverage for chronic conditions.
In Sacramento County, a family of four with an income of $113,000 could see their monthly premium rise by about $1,550 if enhanced subsidies disappear. Alongside this, insurers are projecting a nationwide average premium increase of around 18%.
Dr. David Zonies from the University of Washington’s Harborview Medical Center is particularly concerned. A significant number of his patients rely on Medicaid and ACA plans. He anticipates many will delay necessary health care if subsidies vanish, leading to worse health outcomes in the long run.
The conversation in Congress remains mixed. While Democrats are pushing for an extension of these subsidies, some Republicans are holding out. Senate Majority Leader John Thune mentioned he may be open to discussing an extension.
A June report from KFF reveals that 75% of adults support the continuation of enhanced subsidies, including two-thirds of Republicans. However, any potential extension from a Republican-led Congress might come with cuts to the existing benefits, according to Park.
Cynthia Cox, a KFF vice president, highlighted that many families, including those who might qualify for standard subsidies, would feel the pinch of rising premiums. For many, the option may come down to choosing high-deductible plans. While these cut initial costs, they can lead to significant out-of-pocket expenses if a major health issue arises.
Leighanne Safford remains hopeful yet anxious. “If the subsidies aren’t extended, it would change our lives dramatically,” she said. The uncertainty looms large as families across the nation await crucial decisions from Congress.
For insights into how such policy changes can impact families and health care access, visit KFF.
