Medical costs could skyrocket as ACA subsidies expire
Millions are at risk of skyrocketing health costs in 2026 if Congress fails to extend health care subsidies.
Months after signing up for health insurance in mid-2025, Houston resident Mila Clark crunched the numbers and learned that the Affordable Care Act would no longer be an option in 2026.
The 36-year-old small business owner couldn’t find a plan as cheap as the $350 monthly insurance he had in 2025. The coronavirus-era subsidies that made Obamacare health insurance cheaper are set to expire in December, making premiums much more expensive for Clark and millions of others in 2026.
The additional costs were too great for Clark. In addition to high monthly insurance premiums, she spent hundreds of dollars each month on insulin, an insulin pump, a continuous blood sugar monitor, and medical appointments to treat her type 1 diabetes.
“I was spending over $1,000 a month just to stay alive,” said Clark, a health coach and diabetes advocate who runs the website Hungry Woman.
Clark married her partner Greg in a hastily planned courthouse ceremony on Dec. 1 so he could add her to his company’s health insurance plan instead of enrolling in an ACA plan.
“What’s frustrating to me is that we had to rush the plan,” Clark said. “We had this looming over our heads and the decision was life or death.”
Without the enhanced tax credits, which are set to expire at the end of 2025, the average cost for the 22 million Americans with subsidized ACA insurance would have more than doubled as of January, according to the health policy nonprofit KFF.
The nonpartisan Congressional Budget Office announced in December that an average of 3.8 million Americans are expected to lose health insurance by 2035 as enhanced subsidies expire. Other players, such as Clark, will likely receive coverage elsewhere.
In an election year, where affordability remains voters’ top concern, Congress continues to debate solutions to rising ACA health insurance costs.
On January 8, the House of Representatives voted to extend the enhanced subsidies for another three years. The Senate has already voted against expanding subsidies, so the bill is unlikely to pass. But discussions continue among some senators about a possible bipartisan solution to rising health care costs.
If adopted, CBO estimates that the House bill would increase the federal budget deficit by $80.6 billion by 2035.
With no legal solution in sight, consumers are cutting spending elsewhere to maintain their health insurance.
Wisconsin couple cuts household expenses, no vacation plans
Kelly Berry of Altoona, Wisconsin, and her husband are self-employed and do not have company health insurance. They have relied on Obamacare coverage for doctor visits, annual checkups, vaccinations and other preventive care.
In 2025, each had an individual “bronze” level insurance plan with a $7,500 deductible and a fully subsidized monthly premium. The enhanced subsidy will end in 2026, so you’ll pay a total of $2,300 per month for a plan with an $8,000 deductible. This is the amount that must be paid before most coverage begins.
“Going from zero to $2,300[a month]is a huge financial blow,” said Berry, 58, who works as a consultant and provides peer review services to small businesses.
They cut back on streaming services and cut back on Christmas spending. They probably won’t take vacations, and Berry won’t attend a work meeting scheduled in Nova Scotia, Canada.
Even if you reduce your household expenses, you may not be able to save enough to pay your monthly insurance premiums. She also believes entrepreneurs will think twice before leaving a company that has good health insurance. That means fewer people are starting small businesses, said Kelly, a former University of Wisconsin-Eau Claire business professor who taught market research and entrepreneurship.
“It’s not fair to punish people who are doing their best to maintain coverage and be accountable,” Berry said.
It’s empty when it says “Looking for unicorns”
Fariha Khandaker, a Chicago resident, is still looking for a health insurance plan that provides affordable doctor visits and prescription prescriptions.
“I’m looking for unicorns that don’t exist,” said Khandaker, a self-employed consultant and information technology project manager.
The lowest-tier plan costs $250 a month, but you’ll be charged a 50% coinsurance, she said. This is the percentage of your medical expenses that you must pay out of pocket. She visits a specialist twice a year to write prescriptions for chronic conditions. She was unsuccessful because it did not make financial sense for her to pay higher monthly premiums and spend more of her own money on receiving care.
Khandaker spent days researching health insurance options and was making calls before the Jan. 15 enrollment deadline. She’s not optimistic that she’ll find an affordable plan with good coverage.
She is also losing hope that Congress will find a solution.
“It’s hard to believe they’re letting it expire at a time when the cost of living and inflation are skyrocketing,” Khandaker said. “It’s really tough right now. My rent has gone up. When I go to the grocery store, I’m paying so much more. Now, the same goes for my medical bills (which are also going up).”
After the House vote on Jan. 8, advocates called on the Senate to pass a bill extending subsidies to consumers.
“Millions of Americans, especially young adults and families already facing rising health care costs, rely on these credits to maintain coverage and avoid paying medical bills,” said Christine McGuire, president and CEO of Young Invincibles, a nonprofit health and education advocacy organization.
Doctors prepare for the uninsured
Doctors and clinics that treat people without health insurance anticipate that many Americans will seek treatment after losing insurance.
Federally funded community health centers already care for about 1 in 5 Americans without health insurance. These centers, which are often located in rural areas, predict that an additional 1.9 million to 4.2 million uninsured patients will need care due to the expiration of enhanced ACA subsidies and Medicaid cuts in the Republican 2025 Tax Cuts and Spending Act, according to the National Association of Community Health Centers.
Dr. Kyu Li, president and CEO of the Community Health Center Group, said about 1,800 of the country’s 17,000 community health centers will close due to the financial burden of increasing numbers of uninsured patients.
For people with chronic health conditions such as diabetes, delayed or missed treatment can be fatal. The Community Health Center Group estimates that 5,000 to 6,000 people could die as a result of Medicaid and ACA cuts.
“We are already in a very tough situation,” Lee said. “The impact on patients is immeasurable.”
Contact the reporter at alltuck@usatoday.com.
