Updated December 11, 2025 at 10:30 a.m. ET
Krisa Ostenzo anticipates having to withdraw from her savings to afford her $1,500 monthly health insurance plan once the extended tax credits from the Affordable Care Act (ACA) run out next year.
She and her husband managed an optometry practice in rural Wisconsin for 35 years until his recent passing. Previously, their monthly premiums were nearly $2,000 before the tax credits were introduced in 2021, which significantly reduced their payment to about $500.
Now, as she tries to downsize and sell the business, she received a notice explaining that her individual plan would cost $1,500 a month and come with a deductible of $7,200 without the enhanced credit.
“It’s absurd,” she expressed. “I’ve never seen costs rise like this before.”
Roughly 22 million Americans benefit from these enhanced subsidies, which help lower ACA premiums. However, these subsidies will end this year unless Congress intervenes. If they don’t, KFF, a health policy research organization, forecasts that average premiums for recipients may more than double by 2026.
About half of these recipients are either small business owners or self-employed individuals, similar to Mr. Ostenzo.
The open enrollment period wraps up in mid-January, but with a decision deadline of December 15, time is running out for Congress to take action.
The Senate is set to vote on December 11 on a Democratic proposal to extend the tax credits for three years. However, securing 60 votes to overcome a filibuster, which is likely to fail, will require support from Republicans.
Conversely, Republicans are preparing to propose a healthcare plan that won’t extend any tax credit enhancements. Instead, it aims to contribute $1,000 to $1,500 into health savings accounts for eligible individuals who buy marketplace plans.
This upcoming vote on the Democratic plan comes after tax credits were initially promised to some Democrats in exchange for assistance in ending a prolonged government shutdown.
The overarching view of Obamacare
Established through the Affordable Care Act in 2010, the Health Insurance Marketplace was designed to offer various health plans to individuals without access to Medicaid or employer-backed insurance. It’s also known as Obamacare. The marketplace provides financial aids like tax credits based on income levels.
The concept revolves around harnessing collective bargaining power—much like employer-based insurance—where increased participation can lead to lower overall costs through competitive pricing.
Many Democrats claim the ACA empowers individuals to venture into entrepreneurship without the fear of losing health coverage, though marketplace options were often less attainable for middle-income families that didn’t qualify for initial tax benefits.
In 2021, then-President Biden expanded these tax credits, resulting in record enrollment levels and a significantly lower uninsured rate.
Katherine Hempstead, a senior policy director at the Robert Wood Johnson Foundation, noted that the expiration of these credit enhancements could have significant repercussions. “The role of marketplaces for small business owners and the self-employed has really become crucial in recent years,” she mentioned.
Nearly 20% of small business owners and self-employed individuals aged 21 to 64 relied on the ACA Marketplace for insurance coverage in 2022, according to Treasury Department data.
Hempstead predicts that high healthcare costs may trigger adverse effects on the economy, as entrepreneurs might close or avoid starting businesses altogether.
“People really aren’t discussing how this impacts local communities and job creation enough,” she remarked.
For example, Andrew Volk, 42, from Portland, Maine, shared that he felt secure enough to launch his cocktail bar 12 years earlier due to affordable Marketplace insurance, which proved essential when his daughter faced a complicated birth.
“Without the ACA, my business wouldn’t exist,” he stated, voicing concerns that without strong tax credits, future entrepreneurs might struggle to pursue their dreams.
“This could hamper economic growth for years,” Volk added.
Republicans view tax credits as temporary
Enhanced tax credits were introduced in 2021 to assist Americans in affording health insurance during the COVID-19 crisis, leading to a surge in enrollment. Since 2020, the number of people obtaining insurance through the Marketplace has more than doubled, particularly in states that supported Trump in the 2024 election, like Florida, Georgia, and Texas.
About 92% of the 24.3 million Marketplace users receive some sort of subsidy. If Congress fails to act by the end of 2025, average out-of-pocket premiums could shoot up by over 75%.
The enhancements expanded the subsidies and allowed those with incomes exceeding four times the federal poverty level eligibility, which, for 2025, stands at $62,600 for individuals and $124,800 for families of four.
The Congressional Budget Office suggests that around 4.2 million more individuals may lack insurance by 2034 if the extended credits end, with an estimated cost of nearly $350 billion over the next decade for expanding the premium tax credit.
Should the enhanced tax credits end, as many as 22 million Americans may see their health insurance premiums rise by 114%. Republicans contend that the government should not subsidize health coverage for millions and argue that expanded tax credits aren’t a permanent solution, while Democrats plan to highlight soaring insurance costs ahead of the midterm elections.
Returning to a traditional job
Steve Gomez, 44, from Gilbert, Arizona, previously operated a project management business while his wife had a job with employer-backed benefits, especially valuable when their son Anthony required a heart transplant at six weeks old.
“I managed the finances while she benefited from the insurance,” he explained, noting the substantial costs avoided due to their coverage.
Now, both he and his wife are self-employed, allowing flexibility for their children’s needs, particularly for Anthony, who is now 10 and requires ongoing medical care. Yet, the idea of returning to a conventional job just for benefits lingers in their minds.
The only $2,900 gold plan provided by Blue Cross Blue Shield for next year would actually exclude Anthony’s doctors from their network, necessitating further medical expenses for necessary procedures.
Meanwhile, Ostenzo, 62, from Wisconsin, is contemplating seeking employment solely for insurance until she qualifies for Medicare at 65, but the thought is unappealing.
“I’m not thrilled at the idea of working a full-time job, especially since I’ve always been self-employed,” she shared.
