Source: The Wall Street Journal
Sticker shock over higher costs for Affordable Care Act plans is hitting many enrollees around the country who are now learning about hefty increases in what they might pay next year, putting the healthcare subsidies at the heart of the government shutdown in the spotlight.
When Jessica Bunger saw her plan’s monthly premium for 2026, she burst into tears. Starting in January, her insurance will cost more than $1,100 a month if she doesn’t qualify for a government subsidy. That is more than four times what she pays now, factoring in federal help.
After looking over a notice from her insurer that provided the new rates, “I was sick to my stomach,” said Bunger, a 45-year-old from Fort Myers, Fla., who co-owns a video and photography studio. “I’ve never felt so powerless in my life.”
Bunger regularly sees a specialist for an eye condition and may in the future require surgery to avoid blindness. She can’t go without coverage, she said, but she also can’t afford the full 2026 premium, and she isn’t sure how much federal help she will get next year.
About 24 million Americans enrolled in ACA health plans are getting letters from insurers informing them of their 2026 rates. On Tuesday, the Centers for Medicare and Medicaid Services released rates and other data for plans offered through the federal marketplace, HealthCare.gov. The plans, including pricing, were then posted publicly on HealthCare.gov.
Based on the data released Tuesday, health-research nonprofit KFF said the average increase in premiums for ACA plans will be 26% next year. That figure represents the rise in the total cost of what is known as the “benchmark” plans, which are the mid-tier products in each region that are used to set the subsidy amounts.
Insurers blame the higher rates on increasing healthcare spending, among other factors.
The scope of the rate increases is likely to add fuel to the debate between Democrats and Republicans over the federal government’s shutdown.
Democrats want to continue enhanced federal subsidies that defray health-insurance bills for most ACA enrollees, few of whom pay the full premiums for their plans. The Democrats hope angry ACA policyholders will buoy their arguments. Republicans have flagged concerns about costs and possible fraud, and said they refuse to negotiate the issue while the federal government remains closed.
The impact of the rising premiums and shrinking subsidies will vary depending on individual enrollees’ circumstances. CMS said in a press release that enrollees “continue to have robust access to low premium plans after applying advance payments of the premium tax credit,” or subsidy. The agency said most enrollees using HealthCare.gov will be able to get plans that will cost them $50 a month or less next year, including subsidies.
HealthCare.gov, which for 2026 will be used by 30 states to sell the plans known widely as Obamacare, opened up “window shopping” late on Tuesday, ahead of when enrollees can begin choosing next year’s coverage on Nov. 1.
Across several of the remaining states, pricing has become public in recent weeks as their own ACA websites began showing 2026 plans.
In Idaho, which has its own insurance marketplace, ACA enrollees Chad and Tara Smith learned that they will pay a monthly premium of around $1,000, which is about $290 more than they currently spend, if they keep their same plan next year.
Part of the increase would be due to the loss of their $130 monthly subsidy, which their insurance agent warned will go away if the enhanced federal payments lapse.
“I’m kind of just dumbfounded why it’s going up so much,” said Chad Smith, 51, who with his wife owns a landscaping company in Coeur d’Alene. “It’s a huge jump.”
More than 90% of Obamacare enrollees receive some federal help with their monthly premiums. For most, the amount of their subsidies will shrink if Congress doesn’t continue the higher payments, but they still won’t have to pay the full premiums for their plans.
Others like the Smiths, however, will probably stop getting the help if the enhanced subsidies lapse because their income is too high to qualify under the rules that were in effect before a 2021 law first expanded the government payments.
“How much people pay is more up to Congress than up to insurance companies at this point,” said Cynthia Cox, a vice president at KFF, a health-research nonprofit.
The Congressional Budget Office has estimated that 3.5 million fewer people will have health coverage in 2027 if the enhanced subsidies go away.
Clint and Cindy Kittrell, retirees who live in Pendleton, Ore., have been paying $305 a month for their ACA plan, including help from a subsidy. They will be on the hook for about $2,500 a month next year if they stick with the same plan, their agent has warned.
Clint, 63, has muscular dystrophy, while Cindy, 64, requires regular injections to walk because of crippling nerve pain. Their conditions, they say, require their access to medical care.
But their agent says their fixed income, a combination of pension and Social Security, will be too high to qualify for federal help without the extra subsidies.
With premiums rising and the enhanced subsidies set to lapse, the Kittrells are wondering if they can somehow pay cash to their doctors and delay a costly surgery that Clint had planned for next year, or temporarily relocate overseas where care might be cheaper.
“We can’t afford that premium,” said Clint. “There’s no way.”
