The government shutdown ended without resolving a fight over health insurance. Congress failed to extend enhanced premium tax credits that have helped millions on Affordable Care Act plans since 2021. Senate Republicans have promised a vote on the subsidies before year’s end, but open enrollment is underway and consumers face steep price increases and uncertainty.
Insurers have raised premiums because they expect that without the credits, healthier people may skip coverage, leaving a sicker, costlier pool. Premiums on the marketplaces are rising by an average of 26% next year, according to KFF — the largest increase since 2018. With less than a month before the Dec. 15 deadline to sign up for plans starting Jan. 1, some people may have to pay far more or forgo insurance. Here are some of their stories.
She “can’t swing” an extra $1,000 a month
Amy Jackson, 56, Butler, Mo.
Amy works in medical billing at an independent urgent care and buys coverage on the ACA marketplace because her employer is too small to provide benefits. Her current premium is $275 a month; without the enhanced tax credit it would jump to $1,250 in 2026. Going without insurance isn’t an option: in October she was diagnosed with breast cancer 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.
A retiree who left a small business, Bixon faces 2026 premiums of about $4,500 a month to cover himself, his wife and one son — roughly $54,000 a year — plus potentially up to $15,000 in out-of-pocket costs. He never imagined facing nearly $70,000 a year for health care. He worries prices could keep rising 20%–30% annually and says he can’t risk being uninsured before Medicare 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 treatment for his bipolar disorder
Ezra McKay, 26, Memphis, Tenn.
Working part-time as a bookseller, McKay was removed from his mother’s plan and cannot get enough hours at work for employer coverage, so he buys his own ACA plan. Diagnosed with bipolar disorder, his current premium is $15 a month with subsidies; without them it would rise to about $550, nearly half his monthly income. The insurance pays for doctor visits and medications that have been life-changing. Without coverage, he says he’d risk severe health and housing consequences and is 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 use and ongoing care, Johnson lost access to insurance pre-ACA. Preventive care through the marketplace helped her complete a Master of Social Work and improve 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. She lives paycheck to paycheck as a contract social worker and carries medical-related credit card debt. “Where along the lines did I not do the right thing?” she asks, worried about credit and mounting bills.
To cover an extra $1,300 a month, he’ll stop contributing to retirement
Chris O’Donnell, 58, Richmond, Va.
Laid off this summer and now freelancing, O’Donnell gets insurance through Virginia’s ACA marketplace. He and his wife currently pay $837 a month; without subsidies the cost would be about $2,155 — $1,300 more per month. He plans to pause retirement contributions to cover the premium. His wife has diabetes and is a cancer survivor, and supplies for her insulin pump alone would cost about $25,000 a year, making uninsured life impractical. The couple is considering retiring abroad if health costs keep rising.
With the cost more than doubling, she might forgo health insurance
Celeste Jameson, 41, North Port, Fla.
A paralegal who has lived with endometriosis and substantial medical debt, Jameson’s premium would rise from $266 to $593 next year. She says she can’t afford $593 on top of other living 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 bills piling up.
“I’d rather eat nothing but PB&Js than give up my health insurance.”
Kelly Badeau, Tucson, Ariz.
Badeau currently pays $94 per month for a silver ACA plan after tax credits; her 2026 premium is estimated at about $900. Self-employed for a decade, she calls her current plan the best she’s had — it enabled 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 worries she’ll become disabled without health care
Genna Boatright, 40, Siren, Wis.
Boatright has aggressive rheumatoid arthritis and relies 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. She was pushed to apply for Medicaid after an income change but was denied. She’s overwhelmed and fears that without specialty care and medications she could quickly become disabled.
As a self-employed therapist, her ACA plan is her only option
Kristine Weidner, 62, Branford, Conn.
A psychotherapist who is self-employed, Weidner’s current high-deductible plan costs $589 a month (not including dental); a comparable 2026 plan would cost about $1,691. The rising cost and deductible worry her; including dental could exceed her housing payment. She has no other insurance option and may need to close her private practice and return to the public sector for employer-sponsored coverage. She’s also concerned that clients who forgo insurance could reduce demand for her services.
NPR reporters contributed to this reporting. Margaux Bauerlein and Selena Simmons-Duffin of NPR and Kerry Sheridan of WUSF contributed.