Federal enrollment in the ACA begins without any action on benefits
By Rebecca Pifer | Published: 2025-11-01 04:00:00 | Source: Healthcare Dive – Latest News
Plans to sign up for affordable care began Saturday without any movement in Congress on whether more generous subsidies for coverage would continue beyond the end of the year.
As such, millions of Americans covered by Affordable Care Act plans, also known as Obamacare, are staring at the issue. Radical price increases for 2026. Prices rise significantly, by An average of 26% for the typical plan in the 30 states participating in the federal market, and an average of 17% in states that operate their own exchanges, according to the health policy research group KFF.
But the actual amount low- and middle-income Americans pay for coverage is likely higher than that, as increased financial assistance has covered the brunt of premiums for subsidized enrollees since the coronavirus pandemic.
If Washington remains stuck in an impasse on the issue, those members will see their monthly premium payments more than double in 2026, according to KFF.
Technically, lawmakers have until December 31 to act. But the beginning of open enrollment suggests Congress is approaching a tipping point, experts say.
Consumers could get scared after seeing how much their costs will rise next year on the federal enrollment portal Healthcare.gov or state marketplaces. The longer Congress waits, the less time insurers and state regulators have to reflect the potential expansion of subsidies on sign-up sites and letters to members who may have already decided they can’t afford an ACA plan.
Market experts say the situation will become more difficult if the problem is not resolved before the first week of December. If Congress waits until the end of the year to extend benefits, 1.5 million more people will become uninsured next year compared to the previous extension, according to Congressional Budget Office estimates.
“The longer it takes Congress to come up with a solution here, the harder it will be to implement these processes,” said Chris Haltmeier, vice president of legislative and regulatory policy at the Blue Cross and Blue Shield Association, which represents Blues plans. “We’re very concerned that people will be afraid to buy coverage.”
“Scary situation.”
Americans got an early look at the sticker shock they’ll face next year while “shopping” for plans this month. Healthcare.Gov’s federal marketplace, which enrolls millions of Americans in ACA coverage each year, revealed a preview of its plan on Tuesday.
How the loss of support affects enrollees depends largely on their household income. First, anyone making more than $64,000 a year—just over 400% of the federal poverty level—would lose out on financial aid entirely.
Meanwhile, low-income enrollees may find themselves paying premiums for the first time. Experts say that even if monthly premiums for this group remain low, any increase would be difficult to absorb for Americans living near the poverty line.
Central Bank of Oman estimates About 4 million people will lose health insurance If support ends. Other estimates are much higher: the Urban Institute predicts 7.3 million people would lose ACA coverage§ As a result.
A look at Healthcare.gov shows how painful losing benefits can be.
For example, a family of four living in rural Bulloch County, Alabama, with an annual income of $129,000 would see the cost of the cheapest silver plan rise from $872 per month this year to roughly $1,897 per month in 2026.
Affected enrollees can switch to a less comprehensive plan — such as moving from a silver plan, which has higher monthly premiums but lower deductibles and copayments, to a bronze plan, which has lower monthly premiums but much higher cost sharing.
A Bullock County family will still pay $1,320 for the cheapest bronze plan available in their area next year. Meanwhile, your deductible will rise from $10,000 to $21,200.
Jill Murphy, a 43-year-old community organizer in Macomb County, Michigan, said she may have to go without insurance given the higher rates she will face next year.
Murphy’s insurer, Molina, is not offering her current Gold plan in 2026. She’s concerned that Alternatives won’t cover the doctors she needs to manage endometriosis and menopause, while leaving her unable to cover other expenses.
“It’s scary to think about not having insurance. But I also have to be able to eat, pay my bills and just live. If I can’t afford the insurance and the cost of the care I need, my health will suffer either way,” Murphy said.
Likewise, Jessica Trinidad, a 43-year-old voice actress and mother of two in Des Moines, Iowa, is bracing for increased costs. Trinidad and her children suffer from asthma, so living without insurance is not an option, she said.
“I have to find a way to find coverage or start lowering bills to cover market costs.” “It’s a scary situation,” Trinidad said.
Evolution of the ACA exchanges
The Trump administration has blamed fundamental flaws in the design of the Affordable Care Act – not the looming abyss of subsidies – for the affordability crisis.
In a press release on Wednesday, CMS officials said eligible enrollees will remain so Access to cheaper plans even without subsidies than they would have had before the coronavirus pandemic.
The average after-tax market premium will be $50 per month for the cheapest plan next year. That’s $13 more than in 2025, but $20 cheaper than in 2020 before the coronavirus, CMS said.
However, the pre-pandemic market was significantly different from the market today. ACA enrollment has more than doubled since 2020, rising from 11.4 million Americans that year to a record high of 24 million Americans today.
Experts attribute this growth to enhanced support, which was passed as part of the American Rescue Plan Act in 2021 and extended in the Inflation Reduction Act of 2022.
“It’s scary to think about not having insurance. But I also have to be able to eat, pay my bills and just live.”
Jill Murphy
Regional Organizing Director, Michigan Families for Equitable Care
More insurers have also joined the exchanges, attracted by the influx of members and rising taxpayer funding.
But now, some payers are leaving the exchanges altogether. Others move out of certain provinces or receive steep premium increases.
Insurers say they need to charge higher costs in part because of the impending decline in subsidies. They expect younger, healthier people to leave the exchange faster than older, sicker people, who are more likely to endure price increases to maintain coverage. As a result, risk pools may be skewed sicker and more costly to payers.
Insurers have also absorbed higher costs into the exchanges as Medicare becomes more expensive and enrollees use more of it. Payers particularly point to rising hospital costs, the increasing use of GLP-1s for weight loss and the inflationary cost of tariffs as issues.
Fitch Ratings said Thursday that the sector outlook for U.S. payers is “deteriorating” due to financial risks in the ACA market.
Faced with a hit to the profitability of their businesses in the marketplace, health insurers are putting intense pressure on Congress to maintain financial aid.
“Decisionmakers must take action as quickly as possible to expand health care tax credits and provide immediate relief to millions of hard-working Americans,” AHIP, the largest insurance trade association, said in a statement. Friday statement.
However, lawmakers have made little progress, even as the government shutdown continues for more than one month.
Democrats are calling for support to be extended to its current level, and say they will not vote on a bill to reopen the government without reaching an agreement on the issue. Meanwhile, Republicans say they will not address the issue until the government is funded.
Conservatives open to an extension say it should come with modifications, such as setting stricter income limits, pointing to the high cost of keeping the subsidies as they are. According to the Congressional Budget Office, extending the policy permanently would increase the federal deficit by About $350 billion⁃ During the next decade.
Despite the impasse, Bipartisan Senate Negotiations About reopening the government slope It arrives this week, according to Politico. This is cause for some optimism, despite the passage of time – and millions of Americans currently living in limbo, unsure whether they will be able to afford health insurance next year.
As discussions continued, Murphy urged Congress to think about all the Americans they know who will be exposed to higher costs if support runs out.
“I want legislators to think about their spouses, their children, their families, their friends and their neighbors,” Murphy said. Maybe (legislators) have that privilege and concern themselves. But there is someone they know in their life who they don’t know
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