Health insurance: Premiums soar as ACA subsidies end

A stethescope and Medicare paperwork and card — Many Americans make too much for Medicaid and are too young for Medicare

(Image credit: DNY59 / Getty Images)

It’s now two months since Congress let enhanced Affordable Care Act subsidies expire, said Tracie McMillan in The New York Times, and the horror stories keep rolling in. The end of those tax credits—implemented as a temporary measure during the pandemic—have caused premiums to more than double to an average of $1,904 a month for more than 20 million people enrolled in ACA marketplaces. Caroline Hanssen, a 57-year-old writing specialist in California who makes $75,000 a year, saw her monthly premium go from $406 in 2025 to $1,123 in January. She dropped her insurance and now says she’s living “on a wing and a prayer.” Lance Loewenstein, a self-employed attorney in Missouri making $144,000 a year, said his family is “barely able to cover” the cost of living after his monthly bill jumped from $1,786 to $3,699—more than many people’s mortgage payment. It’s an “untenable” situation that is “fueling distrust, fear, and anger” among Americans already struggling with the affordability crisis. Yet talks in Congress about reviving subsidies effectively collapsed last week.

Households are being forced into trade-offs, said Amina Niasse and Richard Cowan in Reuters. They have to decide between making sacrifices in their budget, “settling for less coverage, or dropping coverage altogether.” Many are doing the latter: ACA enrollment fell by 1.4 million people this year, and the number of dropouts is expected to rise. And if younger and healthier people bail, that would leave an older, sicker population of enrollees who are more likely to require expensive care—which could force insurers to further hike premiums. Letting subsidies expire was “equivalent to a tax hike on middle-class families,” said Rachel Louise Ensign in The Wall Street Journal. Families earning about $128,000 a year, or more than 400% of the federal poverty line, have been especially hit hard. These middle-income earners were “without good options for workplace health insurance,” but make “far too much money to qualify for Medicaid and are too young to enroll in Medicare.” Families closer to the poverty level “are still getting subsidies, but often at a lower level than before.”

Americans looking for alternatives shouldn’t count on President Trump’s “Great Healthcare Plan,” said Lisa Jarvis in Bloomberg. “The details, of course, are scant.” But in essence, Trump wants to shift government funds “toward putting money directly into accounts that consumers can use to pay for care.” Trump has long criticized the Biden-era subsidies “that allowed millions of Americans to purchase better coverage at more affordable prices,” arguing the policy benefited insurers and not consumers. But his solution “amounts to little more than a list of bullet points” about expanding Health Savings Accounts—which are used mostly by healthy, employed Americans. Diverting the money from subsidies to HSAs would “leave many Americans behind.”