With Obamacare’s higher premiums come difficult decisions

Renee Rubin Ross is facing the stark reality of having to pay much more for her health insurance this year, now that Congress has ended 2025 without extending the enhanced federal tax credits that brought down the cost of her coverage under the Affordable Care Act.

"I don't even know how to get my mind around it. It's the opposite of affordable," said Ross, who relies on Obamacare to cover her family of four in California. Staying on the same plan for 2026 will cost about $4,000 a month, $2,700 more than the roughly $1,300 per month she had been paying.

Since the subsidies were first expanded in 2021, allowing more people to qualify and lowering their payments, millions of Americans have benefited. A record 24 million people enrolled in Obamacare for 2025, with a vast majority receiving some tax credits. Many were self-employed or worked for small businesses that did not offer health insurance.

But without the enhanced subsidies, many people are seeing the cost of coverage more than double, increasing by hundreds or even thousands of dollars a month, because the tax credits are now in line with what they were before.

In some cases, people may no longer be eligible for subsidies because they make more than four times the federal poverty level - about $63,000 annually for an individual. In other cases, they will have to pay much more of the total premium, even if they get tax credits.

These higher costs are forcing many people to make hard choices. Some are deciding to go without health insurance; others are choosing a less generous plan that has lower premiums but requires them to pay thousands of dollars more in out-of-pocket expenses.

Still others say they plan to limit what they will make this year so that they can continue to qualify for the remaining subsidies. And like Ross, some are likely to dip into savings to pay the higher premiums.

In many states, including those that rely on the federal marketplace, healthcare.gov, the deadline for enrolling in an Obamacare plan for Jan. 1 has now passed. People can generally sign up in January for a plan that starts Feb. 1.

Congress could still decide to extend the enhanced subsidies sometime this year. But while Democrats have pushed for an extension, even making it a core demand to reopen the federal government during the shutdown in the fall, the Republicans who control Congress remain divided about whether to extend them.

Many blame Obamacare for the high health care costs plaguing the country, but they so far have been unsuccessful in reaching an agreement over an alternative plan.

For Kate and Mark Dwyer, a couple in rural Oregon, the cost of their insurance was poised to jump to nearly a quarter of their annual gross income. Mark Dwyer, 60, lost his job-based coverage when he retired as a residential plumber.

Kate Dwyer, 58, runs a small nonprofit that does not offer her insurance. The cheapest option they could find for themselves for 2026 would cost about $2,000 a month.

The couple decided to keep Mark Dwyer's insurance but cancel his wife's coverage. Their "weird calculus," as Kate Dwyer described it, was that she would have more warning if she were to need care because his family has a history of heart disease.

"There might be more of an on-ramp to some other solutions," she said.

By late December in Pennsylvania, about 60,000 people had terminated their coverage, out of about 500,000 residents who were enrolled in 2025, said Devon Trolley, executive director of the state's marketplace.

"It's a really significant group that has dropped their coverage," she said, adding, "It's tough to see."

Pennsylvania has many early retirees, some of whom appear to be gambling that they can remain healthy enough until they turn 65 and qualify for Medicare, the federal program.

Some couples also find themselves paying much more for insurance because the increased Obamacare premiums paid by one partner come on top of Medicare premiums paid by the other.

"It's an unintentional glitch here that we can fix," said Rep. Mike Levin, D-Calif., who has proposed legislation that would include Medicare costs in calculating tax credits for Obamacare coverage.

Exactly how many more people will be uninsured because of lost enhanced tax credits is not clear. The Congressional Budget Office has estimated that about 4 million people could eventually lose coverage without the expanded subsidies, but the final tally of how many people have enrolled will not be available until early next year.

Most people will still qualify for some level of assistance. But many of those now signing up are confused and anxious about what the change means for them, said Njeri McGee-Tyner, who helps enroll people for Obamacare for the Alameda Health Consortium, a group of community health centers in California.

With the spike in premiums, it can be tempting just to go without.

"We are trying to make certain people understand that it is a hard choice," McGee-Tyner said. She said she reminds them that they could need expensive medical care like surgery or continuing treatment for a chronic medical condition.

Then "what's going to happen?" she asks them.

In spite of the temporary nature of the subsidies, she said, people have not planned for the additional costs. "They didn't predict that this would happen," McGee-Tyner said.

Some are choosing less expensive Obamacare plans - often the lowest tier, called Bronze - that come with a higher deductible and higher out-of-pocket costs before coverage kicks in. "We are seeing a significant movement" into these plans, said Jessica Altman, executive director of Covered California, the state's marketplace.

The California marketplace has also seen a significant drop in new enrollees, Altman said. People who need coverage may not be coming to the marketplace at all or may be looking at the high prices and deciding they can't afford coverage, she said.

Altman said it could take months to see how many people eventually will enroll. Many people will be automatically reenrolled in a plan or will sign up during open enrollment but will never pay the bill from the insurance company to confirm their coverage.

Before the expanded subsidies were in place, Altman said, there was typically a significant drop-off in the number of people who remained enrolled after they got their first bill. "That pattern could come back," she said.

The loss of the more generous subsidies has led Kai Schmoll, a 60-year-old who owns an event staffing business in Asheville, North Carolina, to decide to limit how much money he makes, something that runs contrary to his instincts as a successful small-business owner. "It's what I have to do," he said.

Without the assistance, the same plan for Schmoll and his husband will cost nearly $3,000 a month, compared with the roughly $600 it did in 2025.

"It was a decision I had to make," Schmoll said. He added, "I wasn't thrilled about curbing my income." But as someone who previously had cancer, he said, he felt he could not go without coverage.

"God forbid something were ever to show up," he said. "I would be devastated without insurance."

Schmoll and others are watching closely to see if Congress reverses course in the coming months. A recent poll from KFF, a health policy research group, suggested that the loss of subsidies could affect which candidates voters favored in the upcoming midterm elections.

Ross said she and her family were "standing by and seeing what is going to happen."

But the idea of paying nearly $50,000 a year for health insurance is daunting, even if she can find a way to pay for it. "We're truly in shock," she said.

This article originally appeared in The New York Times.