A Louisiana family paid $300 a month for health insurance. Now it's $2,000 as ACA credits expire.

Victor McQuillen and his wife have relied on an Affordable Care Act marketplace plan for their health insurance for most of the past decade.

This past year, it was a Blue Cross and Blue Shield silver policy that cost them about $300 a month. It saw them through health issues and the arrival of their newborn daughter.

But when the 40-year-old freelance live audio engineer logged in to renew for 2026, the number on his screen made him stop cold. The plan he'd been paying $300 a month for was now listed at roughly $2,000 a month.

"If you qualify for any ACA benefits, then there's no way you can afford to spend $2,000 a month," he said. "That's really a joke. It's not a real number. It might as well be $10,000."

For McQuillen and thousands of others across the state, those "not real" numbers are an early glimpse of what's ahead if Congress allows the ACA's enhanced premium tax credits to lapse after 2025.

The enhanced credits — beefed-up subsidies first created during the COVID-19 pandemic — helped drive marketplace enrollment to record highs and brought average premiums down to about $73 per month in Louisiana.

Steep hikes

The ACA's premium tax credits lower the monthly cost of health insurance for people who buy coverage on the federal marketplace and have low or moderate incomes.

Before the pandemic, eligibility for subsidies was limited to households earning between 100% and 400% of the federal poverty level, with the amount tied to how much of their income they were expected to spend on a benchmark plan.

Pandemic-era changes expanded the credits, lowered required premium contributions and temporarily allowed people above the old income cutoff to qualify. But those changes are scheduled to expire at the end of 2025 unless Congress extends them.

According to estimates from the Center on Budget and Policy Priorities, a nonpartisan research group that supports extending the subsidies, marketplace enrollees in every Louisiana congressional district would face steep premium hikes if Congress lets the enhanced tax credits expire.

Across the state, a 45-year-old earning $32,000 would see their annual premium more than triple, according to the analysis.

The steepest increases appear in U.S. Rep. Clay Higgins' 3rd District, though the pattern is consistent across the state. There, annual premiums for a typical family earning $130,000 would rise by more than $16,000, and a 60-year-old couple could see a $29,000 jump, a 406% surge that represents the most dramatic scenario in the state.

Higgins' office did not respond to a request for comment.

According to Keep Americans Covered, a coalition of health care groups, over 281,000 Louisianans selected a marketplace plan for 2025 coverage through the federal platform. Prior to the subsidy expansion, roughly 100,000 residents were enrolled through the marketplace.

'Very, very few options'

SarahJane Guidry, director of policy and advocacy at CrescentCare, a federally qualified health center, said her staff is already hearing from patients discovering that a plan with a monthly premium of a couple hundred dollars is now closer to $1,000.

"There are very few options," she said. Those options, she added, often boil down to going uninsured, relying on free clinics, or "compromising your family budget to compensate for these increased costs, because you cannot go without health insurance."

Rob Harrison, a 44-year-old licensed clinical social worker in New Orleans, is feeling the hikes on both sides. As a therapist in private practice, he's had his own health insurance through the ACA for a few years and also treats clients who depend on it.

The plan he currently pays about $300 a month for — after a roughly $300 tax credit — will jump to about $850 a month. His deductible would climb from $3,000 to $7,500.

"Obviously because of this, I'm going to have to go up on my rates a little bit," said Harrison, who specializes in trauma therapy and worries his clients will have to prioritize other expenses, or that their deductibles will be too high for them to get therapy. "It has this cascading effect."

The timing is particularly harsh for Louisiana, where tens of thousands have already been removed from Medicaid as the state began rechecking eligibility for the first time since the pandemic.

In focus groups and community meetings, Guidry said she's hearing more stories of people making major life decisions solely to preserve health coverage.

Some Louisiana workers avoid raises or turn down full-time hours because earning more would push their family above subsidy limits. Others delay getting married to keep household income low enough to qualify for assistance, she said.

Critics say credits were meant to expire

The Senate has plans for a December vote on the subsidies, but it's not clear whether House Speaker Mike Johnson, R-Benton, will bring an extension bill to the floor.

On Friday, he told Fox Business that he has not committed to bringing a vote, characterizing the enhanced credits as a "COVID-era boondoggle" created by Democrats and designed to expire.

He said any extension would require "massive reforms," including income caps and Hyde Amendment restrictions, which prevents the use of federal funds for abortions except in some circumstances.

In October news interviews, U.S. Rep. Steve Scalise, R-Metairie, indicated he did not support extending the subsidies. In statements on social media, Higgins said he supports the end of the subsidies.

If the credits were extended in some form, the Louisiana Department of Insurance has previously warned that without direction from Congress, it cannot force insurers to adjust 2026 rates mid-year, even if an extension passes later. That means families may be stuck paying higher premiums all year.

In New Orleans, McQuillen is trying to figure out what to do as his family adjusts to a new baby.

He could chase a full-time job with benefits, walking away from the flexibility of sound-engineering work in the city's music scene. He could also drop his own coverage and keep only a stronger plan for his wife and baby.

Still, he considers his family lucky, because he has contacts that could turn into a job with insurance. He worries that many gig workers will just go without.

"We're gonna make it," he said. "We might have to have an employment shake-up or two, but we'll be OK. A lot of other people won't."