NBC News
Leighanne Safford and her husband, Lorry, pay only $ 278 a month for their medical insurance. But as of January 1, its monthly fee could increase to $ 1,800.
The Safford family is one of millions that could be forced to disburse hundreds of dollars more for their medical insurance installments next year, since the reinforced subsidies of the affordable assistance law (ACA, in English) expire at the end of December.
Extended subsidies were implemented within the framework of the US 2021 Rescue Plan, which caused ACA plans to be affordable for many middle -class families. The Inflation Reduction Law of 2022 extended them until 2025.
However, the Congress, controlled by the Republicans, did not extend the subsidies in either of the two main financing law approved so far this year. It is not clear if they will do so in a bill to maintain government financing until September 30.
For Safford, the effect could be aggravated by the cuts to the extension of Medicaid in the president’s extensive bill, Donald Trump, which was promulgated during the summer. She fears that her 13 -year -old son, Adam, also loses her Medicaid coverage, so the family is also planning to pay her medical insurance in 2026.
Safford said that they cannot pay the monthly fee of $ 1,800, which only includes her and her husband, without having to cut basic expenses such as food or dental care. So they are thinking of changing a cheaper plan with high deductibles that cover the whole family. The inconvenience: although monthly rates are usually lower, they would have to take on higher expenses in their pocket before the coverage enters into force.
“At this time we make the decision based on the fact that we all enjoy relatively good health,” said Safford. “But, as we all know, with health, that could change at any time.”
In 2025, more than 24 million people obtained their medical insurance through the affordable assistance law, according to data from the KFF Health Policies Research Group. Of these, more than nine out of 10 —22.3 million people – met the requirements to receive reinforced subsidies. (That figure includes people who also meet the requirements to receive standard ACA subsidies for people with very low income, who entered into force in 2014 and are expected to continue).
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In Mississippi, Florida, West Virginia, Oklahoma, Louisiana, Utah and Alabama, at least 96 % of Aca affiliates received improved subsidies. The States of New Hampshire and Washington had the lowest rates, with 71 % and 73 %, respectively.
If improved subsidies expire, It is expected that almost 4 million people will be left without coverage in 2026 Because they will not be able to pay the fees, according to a 2024 analysis of the Budget Office of the Congress, the non -partisan agency that advises the Congress on budgetary and economic issues. This figure is expected to increase to almost 7 million people in 2034.
If Congress does not take measures, “millions of people will run out of insurance,” said Edwin Park, a research professor at the McCourt School of Public Policies at Georgetown University. “Without these subsidies, it will be much more expensive.”
“A double blow”
Open registration for next year’s plans begins on November 1. But for many families, the “unpleasant surprise” will arrive in October, when they receive formal notifications with the monthly premiums next year, Jessica Altman, executive director of Covered California, a state market for ACA coverage.
“There’s a lot of fear,” he said. “Whether someone who has cancer or chronic disease and knows that he needs it, or someone who thinks: ‘Maybe he has to do without insurance and cross his fingers.”
Altman set the Sacramento County, where a family of four members with annual income of $ 113,000 could see how their monthly fee increases by about $ 1,550 if government subsidies expire, compared to only $ 112 if they are maintained.
In addition to the expiration of subsidies, states must also take into account the rise in the premiums planned by the insurers for next year.
It is “a double blow: premiums go up and tax credits could go down,” Altman said. A KFF report revealed that insurers that offer ACA plans are planning an average increase in quotas of around 18 % throughout the United States by 2026. If we add to this the loss of subsidies, people could pay an average of 75 % more in premiums, according to KFF.
People who still meet the requirements to receive the standard subsidies of ACA will not be fought either, said Cynthia Cox, vice president and director of the ACA program in KFF. Without improved subsidies, the amount that the government pays for its monthly cousins will be reduced.
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“The effects will be quite widespread,” Cox said. “Virtually all people who buy their own medical insurance will be affected in one way or another.”
In the state of Washington, where Safford resides, Dr. David Zonies said that many of his patients will be directly affected. Zonies is a medical director of the Harborview Medical Center at the University of Washington, a hospital in the security network that largely attends patients from Medicaid and ACA.
The loss of improved subsidies, along with Medicaid cuts, means that many patients will run out of insurance and will delay the attention they need until their situation worsens, he lamented.
“My biggest concern is now the loss of these tax credits,” said Zonies. “We believe we will return to the situation before the approval of the affordable health care law, and that will be really devastating.”
A AHIP spokesman, the main commercial association of the sector that represents insurers, including those who sell ACA plans, did not respond to a comment request.
A struggle to expand subsidies
Park said that it is still possible for Congress to expand improved subsidies, either as part of a government financing package or an independent bill.
“It’s very difficult to predict,” he added. Democrats continue to advocate for the expansion of subsidies, while many Republicans continue to oppose. However, the leader of the Republican majority in the Senate, John Thune, of Dakota del Sur, told the NBC News chain earlier this month that keeps the door open to a possible expansion.
“It is something that, yes, some of our members are paying attention,” said Thune, although he blamed the Democrats for expanding the size of the program and including the gradual elimination of the subsidies.
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The president of the House of Representatives, Mike Johnson, has not spoken on the subject, but kept the door open to an extension of the financing.
Altman indicated that Congress must quickly decide what he wants to do, noting that an extension would not only provide “tranquility” to many families, but also security in their medical care and economic freedom.
A June June report reveals that three out of four adults support the expansion of improved subsidies, including two thirds of Republicans. Park pointed out, however, that the improved subsidies approved by Republicans could not be the same as those who were in force.
“I anticipate that, if Congress Republicans are willing to negotiate an extension of improved credits, try to reduce the generosity of improved subsidies,” he said.
Cox indicated that some families could choose to keep their coverage making adjustments in their budget, but most, such as Safford’s family, will probably go to plans with high deductible plans. Although those who hire these plans must pay more than their pocket before the policy enters into force, the plans are designed to protect against high medical invoices that can be economically devastating.
“Suppose a bus run over, you diagnose cancer or need a very expensive medical treatment. That kind of plan would protect you from those very high hospital expenses,” he explained.
Safford said he continues to “touch wood” so that subsidies are extended. If that does not happen “we would complicate our lives,” he said.
