WA health insurance buyers fret as ACA subsidies remain in limbo

For months, people who buy their own insurance have been grappling with a major uncertainty: How much will coverage cost next year?

Pandemic-era tax credits that have kept premiums low for Affordable Care Act plans are set to expire at the end of 2025. The White House and some lawmakers have signaled openness to temporarily extending them, following a record-long government shutdown centered on the subsidies. But even though open enrollment deadlines are fast-approaching, no deal has materialized. Congress faces a Dec. 11 deadline to vote on tax credit legislation, but details about what a bill might look like are currently scarce.

That means millions, including more than 200,000 in Washington, are facing tough choices about how to afford health insurance next year.

Premium tax credits cap the amount that people have to pay when buying insurance off the ACA exchange. But next year, the subsidies will only be available for people whose income is less than four times the federal poverty level. That means middle-income households that benefit from the tax credits will have to pay full premiums, which can cost anywhere from a few hundred to over a thousand dollars more per month.

Patrick Baumann, 60, has been buying coverage through the ACA exchange for over a decade. He and his wife, Anne Bertino, are self-employed; Baumann is a technical writer, and Bertino works in interior design. Enhanced premium tax credits have helped the couple afford their coverage since the subsidies were first introduced in 2021.

The credits “just worked out really well for us,” Baumann said in an interview last month.

That could change if they earn a little bit more and the tax credits are not extended.

This year, they expect to earn around $74,000. Baumann and Bertino have to be careful to earn around the same amount next year, so that they can keep taking the premium tax credits.

“We have to be very careful about where our income is coming from,” Baumann said. “There can't be any surprises.”

For a household of two, the current federal poverty level is $21,150; four times that equals $84,600.

At their current income, they’ll pay just $4 per month for the plan they’ve chosen for 2026, according to the premium calculator on Washington Healthplanfinder, the official platform where residents buy insurance.

That also gives them some buffer in case extra money comes in, such as through interest or investment withdrawals. However, if the couple ends up making more than the $84,600 threshold, they’ll have to pay over $2,300 per month instead for the same plan, Baumann calculated.

That means a single unexpected paycheck at the end of the year could trigger a massive tax bill.

“It's terrible, right?” he said. “I'm at that age where I know that I'm not sure how much longer people are going to be offering me jobs. I need to make as much money as I can while I can.”

To afford higher premiums, some families are downgrading the type of coverage they get.

Carolyn Nissen, 65, has been looking at options for the past few weeks. While she qualifies for Medicare, her husband gets coverage through the ACA exchange. Both are self-employed and live in North Bend. Nissen is a real estate agent and photographer; her husband is a woodworker.

This year, he’s on a silver plan, which costs around $650 per month. Without an extension of the credits, his premium would increase to around $1,500 per month in 2026.

Rather than eat the cost, Nissen enrolled him in a cheaper bronze plan. If the credits are extended, the plan will cost about $300 per month; if they’re not, it’ll cost around $1,100.

“We're really lucky because we're very healthy,” she said.

She worries that her husband’s new, cheaper plan will have fewer in-network medical providers, limiting his access to care if needed.

For now, Nissen is hoping the credits get extended.

“I feel like this helps people who are in that midrange income,” she said. “Health care for self-employed people has always been so expensive.”

Enhanced premium tax credits didn’t just expand the number of people who can get subsidized ACA insurance. They also reduced premiums for lower-income households.

This means even people who will still qualify for premium tax credits next year will see their insurance costs go up if the credits are not extended.

Erin Murray, as a freelance theater director and a playwright, makes less than $40,000 a year.

In 2026, she expects her monthly premium to increase from around $180 to $215. To afford the difference, she’s decided to forgo dental coverage.

“Because the future is so uncertain, it might just be smart next year to forgo that,” she said. “I felt like that was something that I could manage myself.”

The nonprofit where she directs doesn’t offer health insurance, so being able to buy coverage off the exchange makes it possible for Murray to pursue a creative career. If premiums continue to increase, that puts her work in jeopardy.

“Being able to pay for your own health care as an individual and not as a part of a major company or institution helps Washington thrive.”

Open enrollment closes Jan. 15, 2026. Dec. 15 is the deadline to enroll for coverage beginning Jan. 1, 2026.

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