Policyholders brace for price increases

Talia Mindich of Berkeley will see the cost of her Affordable Care Act health insurance plan rise by $72 monthly next year. Tessa Spargo of San Francisco will see an even bigger monthly premium hike of $143, but sees no way around it - she needs to see doctors regularly for a chronic health condition.

And without coverage, Spargo, a language teacher, said, “you’re really up the creek.”

Mindich and Spargo are among the 2 million Californians and 24 million across the U.S. whose Affordable Care Act coverage costs are set to rise dramatically starting in January, when enhanced tax credits expire. Those credits, which beefed-up government assistance for health care bills, were approved by Congress as the COVID-19 pandemic raged.

What, if anything, Congress will do about the rising costs is now at the heart of ongoing discussions at the Capitol. The stakes are high for millions of patients, and the results could have major political ramifications. Democrats are expected to seize on the expiring tax credits, and unaffordable health care more broadly, in their quest to retake Congress in the 2026 midterm elections.

Open enrollment for Covered California, the state’s version of the Affordable Care Act, also known as “Obamacare,” began on Nov. 1. Enrollees can renew their plan or shop for a different one through Jan. 31.

For many facing rising prices, “their eyes are going to pop out of their heads,” said Larry Levitt, an Oaklandbased policy executive at the health policy group KFF.

Monthly premiums will rise $125 on average for 2026, said Jagdip Dhillon, a spokesperson for Covered California. That’s a 97% increase, he said. The price spikes will vary from enrollee to enrollee, depending on their income, and not every enrollee will see increases. Figures weren’t available for how many are enrolled in the Bay Area.

Along with the expiring tax credits, health insurers in California are raising 2026 premiums for Covered California enrollees by 10%, on average, Levitt said. The costs of delivering care are increasing, and more patients are taking expensive weight-loss drugs like Ozempic, he said.

Insurers are also raising rates in part because the tax credits are expiring. Healthier people may drop their insurance as costs rise, and those that remain in the insurance pool are sicker and require more expensive care, Levitt said.

Kaiser Permanente, the state’s biggest private insurer, will raise rates 7.1%, for Covered California plans, the marketplace reported. In an email, a Kaiser spokesperson said the increase is “lower than the increases seen by most competitors in California markets.”

Anthem Blue Cross, another major insurer, is raising rates 14.5%, for Covered California plans. Spokesperson Michael Bowman said that’s in part because enrollees are relying on emergency rooms for care at twice the rate of patients with employee-sponsored health plans, he said.

Those not on ACA plans also are seeing increases. Mercer’s National Survey of Employer-Sponsored Health Plans projects a 6.7% cost increase for 2026 in the company plans available to most consumers, the largest increase in 15 years.

Some Californians won’t be able to pay the higher premiums. About 400,000 people in the state are expected to lose their Covered California eligibility because of the policy change, according to a report by the Urban Institute, a nonprofit think tank. Of those, 175,000 are likely to be priced out of insurance coverage entirely, the report estimated.

John Murphy, chief medical officer at La Clínica de La Raza, a network of community health centers that serves 83,000 patients at three dozen locations in Alameda, Contra Costa and Solano counties, said rising costs and lost insurance make people less healthy. Patients put off preventative care when it’s too expensive, Murphy said, and then land in a hospital emergency room.

Murphy said the expiring tax credits are only one prong of Republican President Donald Trump’s moves to shift spending on health care from the federal government to states like California.

About 3.5 million Californians are expected to lose Medi-Cal coverage under changes in the president’s “Big Beautiful Bill,” according to the California Budget and Policy Center. The administration says it is preserving benefits for those who truly need them.

In a bid to pressure Republicans, who hold narrow majorities in Congress, to extend the tax credits, Democrats in the U.S. Senate, including California’s two senators, withheld their votes to fund the government. That triggered a partial shutdown that forced essential workers like air traffic controllers and military service members to work without pay, left other federal employees on unpaid furlough, interrupted food aid to the needy and disrupted air travel.

But Republicans held firm, and after a record 43 days, a group of moderate Democrats split with their party and sided with Republicans to fund the government Nov. 12 without immediate concessions on health care from GOP leaders.

Republicans promised to consider the subject this winter, as they search for their own plans to rein in runaway health costs. So far, the Republican administration and Trump’s allies in Congress have yet to nail down their plans to cut health care costs, and the President is so far only speaking in vague terms. In his first term, Trump tried and failed to overhaul the Affordable Care Act, which he’s frequently attacked.

Freshman Democratic Rep. Sam Liccardo, who represents Silicon Valley and the Peninsula, has teamed up with Rep. Kevin Kiley, an Eastern California Republican, to promote a plan to extend the health subsidies, but pare them back to cut the government’s costs.

The duo describe their bill as a compromise, but it’s unclear if it will survive in the Republican-dominated House, where Speaker Mike Johnson has blasted the health tax credits as a “boondoggle.” Republicans slammed Democrats for shutting down the government “in order to give illegal immigrants free health care.” In fact, immigrants without legal status are not eligible for Affordable Care Act assistance.

As the tax credits expire, the Democratic administration of Gov. Gavin Newsom is planning to blunt the rising costs for low-income Affordable Care Act enrollees. The state is planning to offer about $200 million in state tax credits to low-income residents who earn slightly too much to qualify for MediCal - about $25,800 per year for a single person, Covered California said. Medi-Cal is the state’s version of Medicaid, the public health insurer for very low-income people.

But Levitt said the state’s plan benefits only a fraction of the Californians who will bear the rising costs in 2026.

And that leaves ACA plan holders worried about their future. Spargo, a self-employed English and French language teacher, has paid $34 per month for an Anthem Blue Cross plan in 2025. But Covered California recently notified her that she’ll pay $177 monthly for the same plan in 2026, when the credits expire. She said that puts her in a tricky situation, and she’s assessing her options.

Mindich, 35, a Berkeley assistant editor and producer of documentary films, paid $310 a month for her Kaiser Permanente Silver plan, but will see that bill rise to $382 per month in 2026. Mindich said she earns enough to cover the price increase, but that doesn’t mean it won’t hurt.

“It just means I’m not saving money,” she said.