A recent end to the government shutdown left lawmakers without a deal on enhanced Affordable Care Act (ACA) premium tax credits that have helped millions of people since 2021. Although Senate Republicans have pledged a vote on extending the subsidies before the year ends, open enrollment is already underway and many consumers are facing large premium hikes and uncertainty about whether they’ll be able to keep coverage.
Insurers say they must raise rates because, if the subsidies lapse, healthier people are more likely to drop coverage and the remaining pool will be sicker and costlier to insure. Marketplace premiums are projected to increase by an average of 26% next year, according to KFF — the largest jump since 2018. With the Dec. 15 deadline to sign up for plans that start Jan. 1, some people will have to pay a lot more or go without insurance. Below are the stories of several people who could be hit hard.
She can’t “swing” an extra $1,000 a month
Amy Jackson, 56, Butler, Mo.
Amy works in medical billing at a small urgent care and buys coverage on the ACA marketplace because her employer doesn’t offer benefits. Her current premium is $275 a month; without the enhanced credit it would rise to about $1,250 in 2026. Going uninsured isn’t an option: she was diagnosed with breast cancer in October and needs treatment now and follow-up next year. “For them, a thousand bucks is probably nothing. It’s probably what they blow on dinner. But for me, that’s half of my wage,” she says. “I just can’t swing that.”
“A very daunting amount of money” for a retiree
Robert Bixon, 61, Boynton Beach, Fla.
Bixon, who retired from a small business, faces premiums of roughly $4,500 a month to cover himself, his wife and a son in 2026 — about $54,000 a year — plus as much as $15,000 in out-of-pocket costs. That nearly $70,000 total is far more than he expected to pay for health care. He fears premiums could rise another 20%–30% annually and says he can’t risk being uninsured before reaching Medicare eligibility at 65: “I just don’t understand how the leadership in this country can find that acceptable for working-class Americans.”
Fears losing access to bipolar disorder treatment
Ezra McKay, 26, Memphis, Tenn.
Working part time as a bookseller, McKay was removed from his mother’s plan and can’t get enough hours at work to qualify for employer coverage, so he buys his own ACA plan. Diagnosed with bipolar disorder, he currently pays $15 a month after subsidies; without them his premium would climb to about $550 — nearly half his monthly income. The plan covers doctor visits and medications that have been life-changing. Without coverage, McKay says he risks severe health and housing consequences and is even considering moving to a state with more stable programs.
“Where along the lines did I not do the right thing?”
Catriona Johnson, 44, Chapel Hill, N.C.
Born with a congenital abdominal condition that requires daily catheter care, Johnson lost access to insurance before the ACA. Marketplace coverage and preventive care helped her finish a Master of Social Work and stabilize her health. With tax credits she pays $442 a month; without them her premium would rise to $666 and her deductible would increase by $1,000. As a contract social worker living paycheck to paycheck with medical-related credit card debt, she worries about mounting bills and asks, “Where along the lines did I not do the right thing?”
To cover an extra $1,300 a month, he’ll pause retirement savings
Chris O’Donnell, 58, Richmond, Va.
Laid off over the summer and now freelancing, O’Donnell buys coverage through Virginia’s ACA marketplace. He and his wife currently pay $837 a month; without subsidies their premium would be about $2,155 — roughly $1,300 more per month. He plans to stop contributing to retirement to cover the added cost. His wife has diabetes and is a cancer survivor; supplies for her insulin pump could cost around $25,000 a year, making being uninsured impractical. The couple is even considering retiring abroad if health costs keep rising.
With the cost more than doubling, she may forgo coverage
Celeste Jameson, 41, North Port, Fla.
A paralegal who lives with endometriosis and has substantial medical debt, Jameson would see her premium jump from $266 to $593 next year. She says she can’t afford $593 in addition to other expenses and has not yet renewed her coverage. She fears a return to the years before 2014, when undiagnosed severe pain and no insurance led to hospital visits and mounting bills.
“I’d rather eat nothing but PB&Js than give up my health insurance.”
Kelly Badeau, Tucson, Ariz.
Badeau pays $94 per month for a silver ACA plan after tax credits; her estimated 2026 premium is about $900. Self-employed for a decade, she calls this the best plan she’s had — it allowed preventive care and screenings that improved her health. She sold her home last year and plans to use some savings to pay premiums but worries about copays and future costs. Her husband may need prostate cancer treatment; she’s on hormone therapy and blood pressure medication. “I will dip into my savings to make my payments next year,” she says.
She fears disability without specialty care and meds
Genna Boatright, 40, Siren, Wis.
Boatright has aggressive rheumatoid arthritis and depends on medication. She currently pays $12 a month because the enhanced subsidy covers most of her cost; without it, marketplace estimates put her premium near $700. After an income change she applied for Medicaid but was denied. Overwhelmed, she worries that without specialty care and medications she could rapidly become disabled.
As a self-employed therapist, her ACA plan is her only option
Kristine Weidner, 62, Branford, Conn.
Weidner, a psychotherapist in private practice, currently has a high-deductible plan costing $589 a month (not including dental); a comparable 2026 plan would cost roughly $1,691. The higher costs and deductible threaten her finances — including dental could push insurance costs above her housing payment. She has no other insurance option and may need to close her practice and return to jobs with employer-sponsored coverage. She’s also concerned that if clients forgo insurance, demand for her services could fall.
These stories illustrate how quickly budget pressures could force people to sacrifice coverage, care or other financial priorities if Congress does not act to extend the enhanced tax credits. NPR reporters contributed to this reporting. Margaux Bauerlein and Selena Simmons-Duffin of NPR and Kerry Sheridan of WUSF also contributed.