Without subsidies, health care insurance grows distant

ADOBE STOCK

Without congressional renewal of expired subsidies from 2025, health care insurance in the federal exchange will spike in costs.

Open enrollment for health care insurance ends Jan. 15, and with it goes the last opportunity for coverage in 2026.

Congress was supposed to have already decided on whether to extend Patient Protection and Affordable Care Act tax subsidies, but due to a government shutdown from Oct. 1-Nov. 12, 2025, votes are just beginning to take place with the House of Representatives voting to renew subsidies on Jan. 8. The Senate has yet to do so.

However, Americans enrolled in the federal marketplace have already received their new subsidy amount. Those who signed for coverage that started Jan. 1 already have already paid the first month’s premium. The larger issue, however, is how many will have to choose between paying rent or health insurance. 

Natalie Marles, who works at Charlotte Center for Legal Advocacy, is North Carolina benefits navigator program manager and paralegal advocate for Mecklenburg, Cabarrus and Union counties. She said the 2025-26 signup period has been one of the worst in terms of numbers enrolled since she started in 2016. 

“This year open enrollment has been particularly challenging,” Marles said. “This is because of the lower subsidies but also the price of insurance in general is now almost double or triple. In some cases, we have seen some of our own clients that weren’t able to afford insurance, and some have had to decide to eat and pay rent or to have insurance. So, we’ve definitely seen a decrease in enrollment this year. I would say maybe 60% of our clients still enrolled in a marketplace plan, but the other 40% are not going to be insured for 2026, which is very sad.”

Marles said some clients were able to qualify for Medicaid plans, but not many. The Medicaid income cut-off is generally based on 138% of the federal poverty level. It was expanded in 2025 in some states — North Carolina among them — to $1,304 per month. Now, it is $1,800 per month for individuals and $3,065 for a family of three. 

The increase helps a fraction of Americans who need health coverage. Another thing Marles said is that some clients must change their plan tier. In the healthcare marketplace, there are five categories of plans: Bronze, Silver, Gold, Platinum and Catastrophic. The tier selected determines the amount paid for healthcare visits, deductible and out of pocket fees. 

People that need more frequent care would likely need a Silver or Gold plan to lower costs. But, many don’t have that choice because those plans are so expensive that without a substantial subsidy, it is unaffordable, because of larger out of pocket costs. 

“Some have to choose a Bronze plan, which is not ideal, because some of them have a really high need for medical attention,” Marles said, “so the co-pays and the deductibles for a Silver for a Bronze plan, each much higher than for a Silver plan that they were qualifying before. 

“A lot of my clients, actually, the ones that are insured, are choosing a Bronze plan instead of a Silver plan. They were paying like $50 for a Silver plan last year. Now they have to pay $300, so that's not affordable for them anymore. They have to choose maybe a Bronze plan, which they are going to pay pretty much the same that they were paying, but for a very higher deductible. Some of them didn’t even have a deductible in 2025 and now they are going to have $9,000 or $7,000 deductible in 2026.”

The Senate vote on the tax credit extension date has not been finalized yet due to partisan differences on the extension. The Senate is majority Republican (53 of 100 seats) who have been mostly in opposition of the ACA extension, so there will be pushback. Meanwhile, more Americans will go uninsured. One possibility is extending the open enrollment period if the Senate passes the subsidy bill to let people whose plans lapsed re-enroll. 

“You never know when you have some type of accident at work or maybe some car accident,” Marles said. “With the ACA, you are insured. Right now, the cost of health in the United States is very expensive. Just to go to the emergency room is going to cost you at least $1000 or $1,500 just to go there and give your name, right? So having health insurance will prevent you from having higher bills, or maybe even have to file bankruptcy or have a really high debt. … Hopefully the extension of the subsidies will pass, and we’ll really have to think about health insurance in future elections.”

Comments