Anxiety and uncertainty loom for 300,000 Coloradans who buy health insurance on their own

As the time draws near to select a health insurance plan for next year, these are the numbers that Kelli Fritts can't stop thinking about.

$889.84: The monthly premium for her current silver-level plan, the least-expensive silver plan available for someone her age in Denver who buys their coverage on their own.

$34.17: The amount she actually pays every month.

$855.67: The amount of federal subsidies she receives every month that makes her plan — which also comes with a $5,500 deductible and $9,200 annual out-of-pocket maximum — affordable to her.

Approaching 60 and dealing with what she described as a slight chronic inflammatory condition, Fritts, a former health insurance broker, needs access to health care.

"There's no way I'm going to go without insurance," she said.

And, yet, less than a week before open enrollment begins for 2026 insurance plans, she and more than 300,000 other Coloradans who buy their own coverage have no idea how much that commitment will cost next year.

State insurance regulators — working to assess the impact of recent federal legislation and the looming expiration of some significant federal insurance subsidies — still have not released the final prices for 2026 plans. That is expected to change this week, but that hardly brings comfort to Fritts and others like her.

While it's not unprecedented for rates not to be released until late October, this year's prices are likely to bring significant sticker shock. When insurers first submitted their rates back in July, they proposed price increases that averaged 28% for 2026. Action taken during the state legislature's special session is expected to scale that back somewhat.

Fritts, in her mental math, has been guessing her premium will see an 18% increase — about $160 a month. But she is also expecting that perhaps all of her federal subsidies will go away, as Congress grinds through a government shutdown focused on whether to extend those subsidies.

If that happens, Fritts estimates she will pay $1,050.01 a month next year to keep her current plan, a 2,973% increase.

That's an extreme example, but Michael Conway, the state's insurance commissioner, said last week that massive effective price increases are heading for nearly everyone who buys their own coverage unless Congress acts — quickly — to extend the expiring subsidies.

His office estimates people statewide will see a 160% increase in what they pay, on average. It will be worse in areas outside of the Front Range, with the estimated average increase there exceeding 300%.

"I don't think people realize how bad this is going to be," Fritts said. "And I don't think they have a plan for what they're going to do."

"Enhanced" … and expiring?

Let's just be honest here: Almost nobody likes to think about health insurance. One of Conway's favorite jokes to tell at news conferences is that if you know the name of your state's insurance commissioner, something has gone seriously wrong in your life.

But understanding how the insurance gears spin is key to understanding why the federal government is shut down and also to understanding the potential impact that could ripple through both the Colorado health care system and the economy at large.

So, the basics. As health care costs have risen dramatically, health insurance has gotten really expensive. You may not realize how expensive because, often, someone else is helping to pay the bill.

In Colorado, roughly 40% of people are covered by the government programs Medicare or Medicaid, which are at least partly paid for by taxpayers. Half of Colorado's residents get their insurance through an employer, meaning their companies pick up a big chunk of the charge. Nationally, employers pay somewhere between 70% and 80% of their employees' health insurance premiums.

Historically, people who bought insurance on their own had to shoulder the entire premium cost. In Colorado, about 5% of people purchase coverage this way.

The Affordable Care Act changed the math by creating government subsidies — officially, they're known as advanced premium tax credits — to help people buy coverage. Congress then doubled down during COVID and passed enhanced subsidies that were both more generous to those already getting help and newly available to people who previously earned too much to qualify for support.

Those subsidies helped keep people insured during the pandemic, and they also helped flatten the impact of rapidly rising health care inflation. Insurance got more expensive at the same time that a lot of people paid less for it. The result was record sign-ups for people buying coverage on their own, both nationally and in Colorado.

But now those enhanced subsidies are set to expire at the end of the year. This would mean that everybody getting a subsidy — roughly 80% of the people signing up for coverage through Connect for Health Colorado, the state's insurance exchange, receive federal support — would see an increase in what they pay. Some people, perhaps like Fritts, will fall off the subsidy "cliff" and lose their support altogether, forcing them to pay full price.

The state estimates that 75,000 to 100,000 people will drop coverage and become uninsured as a result of these price increases. And that only makes matters worse.

Insurers predict that those dropping coverage will be disproportionately healthier — meaning they are cheaper to insure. That creates what is known in the industry as "adverse selection." The remaining people in the insurance pool are also more costly to cover, creating a loop that drives up prices, which causes even more people to drop coverage.

"We're about to hear stories that are going to be tragic," Conway, the insurance commissioner, said at a news conference last week. "You're going to hear families that are making the choice between paying their mortgage or keeping their access to health care."

Shut down showdown

One way to avert this crisis would be for Congress to extend the subsidies. That is what Democrats in Congress want to do, and it's one of the main reasons for the government shutdown.

"We're smack-dab in the middle of the government shutdown because the Republicans in Congress are ignoring the fact that health care costs are about to skyrocket in this country," Colorado U.S. Rep. Diana DeGette, D-Denver, said at last week's news conference alongside Conway.

Republicans in Washington are divided on whether and how to extend the subsidies, but they say that re-opening the government is a condition of having the debate. Many also say the subsidies are masking deeper problems with health care costs that need to be addressed.

"Long term, we need to look at systemic fixes to the cost of health care," U.S. Rep. Jeff Hurd, R-Grand Junction, told NPR. Hurd has co-sponsored a bill that would extend the subsidies for a year.

The showdown in Congress has made it near-impossible for states to approve rates for next year. Colorado regulators have now asked insurers to submit three different sets of prices for 2026 as circumstances change. That includes a set of prices that reflect what insurers would charge if Congress extends the subsidies last-minute.

"We stand at the ready as the state exchange to be prepared to move heaven and earth to get this through as quickly as they can get something done," Kevin Patterson, the CEO of Connect for Health Colorado, said last week.

Conway said this could mean actually changing the prices in the middle of open enrollment if a subsidy extension comes after Nov. 1. If an extension were to come after Jan. 1, when the new insurance plans start, that would be tougher, but Conway said the state would still act.

"We're going to figure this out," he said.

"What can you cut?"

For Coloradans who buy their own coverage, that message is reassuring, but it doesn't exactly quell their anxiety.

Take the example of Chelsey Baker-Hauck, an independent consultant living in Denver. Baker-Hauck suffered serious heart damage from a COVID infection that also triggered an autoimmune disease, and now she takes medications and receives treatments that total hundreds of thousands of dollars per year.

Insurance picks up most of that — though she, of course, maxes out her out-of-pocket expenses pretty quickly each year and also pays out of pocket for medical care that insurance doesn't cover. But, she said, that underscores the point: For her, it's not really insurance in the sense that it's something she buys in case things go wrong.

This is how she keeps herself alive.

"My life and my ability to continue working and contributing to the community depends on access to insurance," she said last week, speaking via videoconference at the news conference with DeGette and Conway. (Baker-Hauck, 52, said she is an unaffiliated voter and was speaking to advocate for a policy, not to promote one party over another.)

So when she thinks about price increases for insurance, she doesn't think about whether she will hold onto coverage. She thinks about what else will happen.

"Do I pay for health care or do I buy food? Do I pay our $300 heating bill each month?" said Baker-Hauck, who estimated that health care costs could eat up 50% of her income next year if the subsidies expire. "Millions of Americans are making these same kinds of hard choices every day when there's nothing left. What can you cut?"

Fritts, the former health insurance broker, said she would also look at places to cut or savings to dip into. She said she's lucky that she's in overall good health — at least for now — and has savings. She's just a few years out from Medicare eligibility. She'll get through this.

She hopes.

"It does force the question of what you're going to do," Fritts said. "I can't say I've fully answered that."