Facing a subsidy sunset, Montanans brace for health insurance increases

As a self-employed rancher operating a family business in Busby, about an hour and a half east of Billings, Kirby Walborn has purchased his health insurance through the federal Affordable Care Act marketplace for years.

For the most part, Walborn, 63, said the Obama-era health insurance marketplace has held up to its "affordable" moniker. He estimated that the plan covering him and his wife currently costs about $650 a month in premiums — a slight increase from what Walborn said he paid in 2024.

But when he logged onto the federal marketplace this month to re-up his family's plan for 2026, Walborn saw much more than a small price increase: the premiums were set to spike to roughly $2,400 a month — a nearly 270% increase.

About 77,000 Montanans purchased health insurance coverage through the marketplace last year — a key resource for people who don't have health insurance from an employer and are either too young to qualify for Medicare or make too much to qualify for Medicaid.

Most of those enrollees, about 67,000, currently qualify for a subsidy to help keep their premiums affordable — the average monthly discount this year is $545. But for many residents, such as the Walborns, enhanced financial support made available during the pandemic is set to expire at the end of 2025, with no alternative affordability plan in place.

Some of the people health experts say will be hit the hardest by the loss of subsidies include older adults who make more than 400% of the federal poverty level, or about $85,000 for a family of two.

Walborn said he won't qualify for any subsidy in 2026. For him and other Montanans who spoke to MTFP, the sudden end to the enhanced subsidies has made it financially painful or downright impossible to afford health insurance next year. Some, like Walborn, are scrambling to come up with hundreds or thousands of dollars more a month to pay for insurance.

"It's kind of a shocker, but I'm in a bind. I can't go without," Walborn said.

Walborn has an iron disorder that requires him to get his blood drawn every few months. He worries about a future cancer diagnosis after a recent MRI identified a lump he needs to have biopsied. And, in his line of work, Walborn has also faced the occasional emergency. This spring, he got into a bit of a tumble with an ATV, he recalled, resulting in a broken pelvis.

"I've got to have the insurance," Walborn said, noting that it will be more than a year until he becomes eligible for Medicare

Other Montanans, expressing a mix of fear and resignation, told MTFP they are planning to go without any coverage at all.

"I'm not going to get insurance unless the subsidies change. If those don't continue, there's no way I could afford it," said Jacklynn Thiel, 61, a retired state employee who lives in Boulder.

Thiel said that, with the enhanced subsidies, she currently pays no monthly premium. Next year, her costs for a catastrophic, high-deductible plan is set to increase to $785 a month. Thiel said that difference has made her decide to go without insurance next year.

"If I have no insurance and then go into the hospital, they'll still treat me and I'll claim medical bankruptcy," she reasoned. "… I think medical bankruptcy is the better option."

The question about whether to extend the enhanced subsidy policy was at the root of the federal government shutdown that stretched from Oct. 1 to mid-November. Congressional Democrats pushed for an expansion to current subsidies, while Republicans said that debate should happen separately from the vote to fund the government.

The four members of Montana's delegation, all Republicans, have expressed fierce opposition to continuing the expanded subsidies, calling them a giveaway to insurance companies that adds fuel to the fire of exponentially increasing health care costs. Some have also long opposed the Affordable Care Act, blaming it for driving up the cost of premiums.

"Nothing has contributed more to increased cost of health care than the Affordable Care Act," said eastern Montana Rep. Troy Downing, a freshman congressmember and Montana's former insurance regulator, in a November interview with NBC Montana.

When asked in that interview about Montanans impacted by the end of the enhanced subsidy, Downing said that the pandemic-era expanded financial aid has made up a "really small amount" of the total subsidies Montanans receive through the ACA.

"Most of those folks are going to be just fine with or without that," Downing told the interviewer.

Walborn, who said he spent most of his life aligned with the Republican party, has more recently found himself rooting for the Democrats, in part because of the issue of health care affordability. He said he was following news of the federal shutdown closely and watched as a faction of Democrats "caved" by voting to reopen the government, punting the debate about insurance subsidies to a later date.

In the last few weeks, Walborn took time to write to Downing, who represents his congressional district. In his email, he urged the congressmember to extend the enhanced subsidies to "help make health insurance affordable for working Americans like me."

"Losing that support would mean choosing between healthcare and other basic needs — a choice no American should have to make," Walborn wrote.

In a mid-November email responding to Walborn, Downing's office thanked him for his input on the ACA, but noted that the enhanced subsidies were originally passed as a temporary measure during the pandemic.

"Clearly, the pandemic is well behind us," the email read.

Other Montanans said they felt politically mobilized by the looming cost increases for health insurance. Timothy Stevens, 58, a longtime conservation advocate who lives in Livingston, said he was closely monitoring the federal shutdown because of its impact on national parks and federal employees.

But at some point in reading national headlines over the fight between Democrats and Republicans, Stevens recalled, it clicked for him that the health insurance issue was the most central to his own life.

"Then I realized, wait a minute, I'm the person that they're talking about that they shut the government over," Stevens said in a November interview. "I am the person who has been receiving this enhanced subsidy."

Currently, Stevens said he and his wife pay about $1,200 in premiums for a monthly plan, an amount he described as painful "but doable." With the end of the enhanced subsidy, the same plan would cost his household more than $2,800 a month, he said. The couple has decided to divert money from their retirement contributions to cover the new expense.

Like Walborn, Stevens said he was keeping a close eye on Montana's congressional representatives for possible solutions.

"Where is the Montana delegation?" Stevens posed. "This is like a fundamental thing. If we can't take care of our health care, I mean, like what is this country coming to? And what do these guys care about? Because it sure ain't me."

In a November hearing about health insurance policy, Republican members on the Senate Finance Committee proposed other policy fixes for the increasing affordability crisis, including expanding use of pre-tax Health Savings Accounts (HSAs) for users to draw on for routine health care needs. Other Republicans criticized Democrats for taking a "business as usual" approach to the Affordable Care Act by continuing to give subsidies directly to insurance companies.

During the hearing, Montana Sen. Steve Daines reiterated his frustrations with the Affordable Care Act, or Obamacare, but said little about alternative policies to keep insurance prices down for consumers.

"I believe any path forward on this issue requires reforms to address the root causes of why? Why does Obamacare perpetuate high costs and instability, as well as the substantial growth in improper enrollment, fraud, and wasteful spending," Daines said. "In addition to permanent structural reforms to Obamacare, any path forward should expand access to and unleash free market, patient-centered solutions President Trump championed during his first term to provide lower costs, more control, and better care for individuals. I think both sides should agree we need that, and we need it badly."

A spokesperson for Daines' office did not respond to a question about specific alternatives the senator supports in place of ACA subsidies.

Other free market health care reform advocates say there's promise in the talk of expanding access to HSAs, rather than passing subsidies to insurance companies. Kendall Cotton, president and CEO of the Montana policy group the Frontier Institute, said an early November social media post by Trump calling for health policies to "pay the people, not the insurance companies," could eventually help Montanans access health care outside of a restrictive insurance plan.

"I think the whole point is you're putting people in charge of their own health care decisions. They don't have to be bound by insurance networks," Cotton said. "… It's allowing people just to shop for the best health care that they can find at the best value."

Members of Congress and the Trump administration have so far failed to come forward with a proposal to prevent marketplace enrollees from seeing sharp cost increases in the new year, despite the president considering an extension to subsidies. The deadline for signing up for a plan through the ACA marketplace with a Jan. 1 start date is Dec. 15.

In Montana, some residents have bitterly accepted the looming price increase, preparing to shuffle money around to make ends meet or going without insurance entirely.

Shelley Eisenrich, a resident of Hot Springs about an hour south of Kalispell, said her wife has decided to forego insurance until she turns 65 next year and becomes eligible for Medicare, the federal program for which Eisenrich already qualifies.

Her wife's current plan through the ACA costs about $540 in monthly premiums, Eisenrich said. Next year's premiums for the same plan are estimated to be closer to $1,200 — a cost the couple says they're not willing to pay.

Without any chronic conditions, Eisenrich said it makes more sense for her wife to temporarily go without insurance.

"We both agree that she should just wrap herself in bubble wrap for the next seven months," Eisenrich said.