A major milestone in the government shutdown is just around the corner
The ongoing government shutdown could disrupt paychecks, Head Start programs, and health benefits by November.
Brittany Rush’s mother and sister, both health care workers, convinced her to get health insurance.
When the Boise resident looked at her options on Idaho’s Affordable Care Act Marketplace, she was surprised by how little she was paying in premiums. She chose the mid-level Silver plan for $4 per month in 2024 and renewed the plan in 2025 for less than $33 per month.
To maintain the plan until 2026, Rush requires you to pay more than $400 per month.
Because Congress has not extended pandemic-era subsidies that make ACA plans cheaper for millions of Americans, many consumers will find out a nasty shock in their 2026 ACA insurance options when applications open on November 1st. Congressional Democrats have refused to approve a federal spending bill that does not extend the aid, sparking a month-long federal government shutdown.
Idaho residents who started enrolling on Oct. 15 are already struggling with rising premiums.
Unable to pay more than $400 a month in premiums, Rush contacted an insurance broker and found an ACA plan that cost about $124 a month. This is still too expensive for Rush, who juggles her cleaning business with daily living expenses.
“So my plan right now is to be uninsured by the end of the year, and starting in 2026, I won’t be able to get health insurance,” said the 38-year-old Boise resident. She added that next year she will likely be paying cash for doctor’s visits.
She is one of the thousands of Idaho residents who state officials expect to discontinue their ACA coverage. A similar scenario is expected to play out across the country, with more than 4 million people expected to lose insurance as pandemic-era subsidies expire, according to Congressional budget forecasters.
Insurance premiums increase by 75% for Idaho consumers
When the state opened enrollment on Oct. 15, insurance coverage officials there responded to a surge in phone calls and online chats. The state automatically renewed insurance plans for 2026 and notified consumers by email and regular mail of how much they expected to pay in premiums next year. Consumers have until December 15, 2026 to change or cancel their plan before coverage begins on January 1, 2026.
Approximately 115,000 Idaho residents are enrolled in ACA health insurance plans, and an additional 20,000 are enrolled in dental insurance plans.
Pat Kelly, executive director of Your Health Idaho, a state website where people can sign up for ACA plans, said state officials expect 25,000 Idahoans to cancel their health insurance because federal aid expires and they will end up paying higher co-payments for their insurance plans. Next year, the average price of an ACA insurance plan in Idaho is scheduled to increase by about 10%. But without the enhanced tax credit, consumers would pay 75% more in premiums, or about $100 a month, Kelly said.
And Maria Rogers, an insurance broker in Idaho, said she expects insurance premiums to rise higher in many states than in Idaho.
“It’s causing great anxiety across the country,” Rogers said.
Unless Congress reaches an agreement, insurance subsidies would return to the levels they were in the Affordable Care Act. This was the 2010 health care law signed by President Barack Obama that limited cost-saving tax credits to people with incomes up to four times the federal poverty level. Congress has temporarily approved additional, more generous subsidies during the coronavirus pandemic to help more Americans afford health insurance. The United States has declared the COVID-19 public health emergency to end in 2023, and enhanced ACA subsidies are scheduled to expire at the end of 2025.
People who earn more than four times the federal poverty level will have to pay the full cost of their ACA plans as pandemic-era subsidies are ending. Additionally, while low-income Americans are eligible for Obama-era subsidies, they are not eligible for coronavirus-era subsidies that drastically reduced out-of-pocket costs.
People with incomes above four times the federal poverty level ($62,600 for an individual and $128,600 for a family of four) must pay the full monthly premium to maintain ACA coverage.
A family of four in Idaho with an annual income of $130,000 would see their health insurance premiums rise by about $17,000 a year for a mid-level “Silver” plan, a “pretty significant impact,” Kelly said.
Kelly said the state’s ACA enrollment has jumped 84% since 2022, thanks in large part to pandemic subsidies and assistance to consumers.
“The overall uninsured rate in Idaho has decreased significantly, and enhanced tax credits were a big part of that,” Kelly said.
Living without health insurance is not an option
Kathy Newcombe of McCall, Idaho, and her husband are among those not eligible for the grant. The retired couple, whose income is more than four times the federal poverty level, would lose the $656 monthly tax credit that made insurance more affordable.
Their monthly premium will rise from $1,457 to $1,625 and must be paid in full. Combined with higher monthly premiums and the loss of enhanced subsidies, this means the amount you have to pay more than doubles.
Newcombe, 63, had employer-sponsored health insurance for decades until it ended in July. She and her husband, Bill, enrolled in an Affordable Care Act plan as a stopgap until they became eligible for Medicare, the federal health care program for adults 65 and older.
Living without health insurance is not an option. Newcombe has type 1 diabetes and uses an insulin pump and other expensive consumables. The Medtronic insulin pump she uses costs more than $10,000, but she expects it to last until she becomes eligible for Medicare.
You will also need insulin, a continuous glucose monitor, an insulin pump reservoir, and an infusion set. She pays about $2,500 every three months for these items. They chose a bronze-level ACA plan with a $7,500 deductible. This is the amount that must be paid before most coverage begins.
“Your (insurance) premiums will increase by 103%, but you’ll still be spending $2,500 every three months just to continue insulin pump therapy,” Newcombe said.
Newcombe said she and her husband will be able to cope with the increased expenses, but she worries about people who can’t afford the higher premiums on top of their living expenses. As a member of the Diabetes Advocacy Coalition, she is especially concerned about the millions of Americans who need insulin.
Approximately 2 million Americans with type 1 diabetes take medications to regulate blood sugar levels because their bodies do not produce insulin. Millions more people with type 2 diabetes take insulin as the disease progresses.
Insulin-dependent patients who limit their medication due to cost may face costly and life-threatening health complications.
“I can say that Congress knows and is aware of it, but it doesn’t put it into practice every day,” Newcombe said.
Oz: Corona-era subsidies were temporary
Millions of Americans with ACA health insurance are learning about the soaring premiums experienced by residents like Rush and Newcomb.
The federal marketplace healthcare.gov posted pricing and other details about the 2026 plan on Oct. 29, ahead of the start of applications on Saturday.
The cost of health insurance sold in the Affordable Care Act market is expected to rise by an average of 26% next year, according to KFF, a health policy nonprofit.
The amount most consumers will pay will rise further. Of the approximately 24 million Americans enrolled in ACA plans, approximately 22 million receive subsidies to help cover costs. According to KFF, average out-of-pocket costs will more than double as consumers lose access to enhanced coronavirus-era subsidies.
General inflation was such a hot topic in the 2024 presidential election that it’s “surprising that we can’t come to an agreement sooner to prevent premium increases of this magnitude,” said Anthony Wright, executive director of the advocacy group Families USA. “This is much higher than the price of eggs and other daily necessities.”
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, which oversees the ACA market, defended the decision not to extend the pandemic-era subsidies.
His agency distributed a fact sheet saying that next year most consumers will be able to access ACA coverage that costs less than $50 a month.
Oz said at a press conference Wednesday that “hair-pulling and scratching (and) mud-throwing” does not address the big issues facing American health consumers. He said he hopes the Trump administration will reopen the government to bring in experts who can “come up with a more comprehensive way to address the larger and more costly challenges facing the United States.”
He added that the coronavirus-era subsidies are “a temporary measure to help us get through the coronavirus. And I think everyone agrees that coronavirus is behind us. So the coronavirus-era subsidies should also be passed.”
Email consumer health reporter Ken Alltucker at alltuck@usatoday.com..
