Oregonians who buy health insurance through the Affordable Care Act (ACA), commonly known as Obamacare, may face increased costs next year with no definite solution in sight. The upcoming federal spending package intended to prevent a government shutdown does not address the expiring enhanced premium tax credit that has supported health insurance for millions, including many in Oregon.
The proposal merely offers a commitment to vote in December about renewing those pandemic-era tax credits, which will end if Congress doesn’t act. The House is expected to vote on this stopgap funding bill soon.
The situation is more pressing as open enrollment for 2026 coverage is already underway. In Oregon, enrollment for plans set to start on November 1 will run from November 1 to December 15, with registration possible until January 15 for coverage beginning in February.
As the government deal progresses, it’s important to understand what it means for enhanced ACA subsidies and for Oregonians who count on them to keep their health care affordable.
What about ACA subsidies?
The ACA aimed to provide health insurance to those without coverage from work or government programs when it passed in 2010. The law established Health Insurance Marketplace Plans and included income-based subsidies to limit what participants would pay for standard plans.
Originally, only households earning between 100% and 400% of the federal poverty level qualified for premium tax credits under the ACA. However, during the pandemic, Congress temporarily boosted subsidies through the American Rescue Plan and subsequently extended them via the Inflation Reduction Act. This meant that low-income individuals could obtain a plan without a monthly premium, while even high earners wouldn’t pay more than 8.5% of their income for premiums.
That said, these broadened subsidies weren’t permanent. If Congress doesn’t act, they will expire at the year’s end and support will revert to pre-2021 levels.
If these enhanced subsidies continue, the Congressional Budget Office predicts a $23 billion increase in the national deficit next year, with an estimated $350 billion added over the next decade.
Who and where in Oregon will see a change?
For most Oregonians, the impact may go unnoticed. The bulk of residents are insured through their jobs or the Oregon Health Care Plan, the Medicaid program that serves about a third of the population, and these options don’t depend on federal subsidies.
Around 140,000 Oregonians purchasing insurance through the ACA’s Marketplace — about 3% of the state’s population — would feel the changes. Of these, approximately 111,500 receive subsidies for their premiums this year.
The effects will not be uniform across the state. Data shows that rural counties, despite having lower enrollment numbers, have a higher proportion of residents relying on subsidies. More than 90% of Marketplace enrollees in Malheur, Baker, Morrow, Grant, Harney, and Umatilla counties have received financial support this year.
Another group notably affected includes about 35,000 Oregonians earning over 400% of the federal poverty level, which is roughly $84,600 for a couple. These households will lose all federal financial aid and will be left to pay full-price premiums for their plans.
Counties like Hood River, Deschutes, and Benton have high proportions of high-income ACA enrollees, where about a third of participants earn too much to qualify for assistance under the original ACA rules.
How much will ACA premiums increase for Oregonians?
If the current bill succeeds and Congress does not renew the enhanced pandemic-era subsidies, Obamacare enrollees would still qualify for assistance, but it would be significantly lower.
Insurance companies in Oregon are already anticipating these changes in their 2026 premiums, with an average increase of about 10% expected. Nationwide projections indicate a heftier average rise of around 26%.
Experts contend that the greater issue lies in lost subsidies rather than just premium costs. Oregon Health Authority estimates suggest that Marketplace subscribers could face increases of $127 to $456 monthly, depending on their income.
“A 10% hike in average premiums is what insurers are charging, not necessarily what consumers will bear,” explained Rajiv Sharma, a health economist at Portland State University. “Some individuals might see a much steeper rise if the enhanced tax credits are eliminated.”
Currently, those earning more than four times the federal poverty level ($62,600 for individuals, $128,600 for families of four) pay at most 8.5% of their income in premiums. If no action is taken, that cap will vanish on January 1st, which could cause some monthly premiums to more than double. For instance, a standard medical plan for a couple in Portland that costs $1,423 monthly could drop to $850 with enhanced subsidies.
Sharma noted that middle- to moderate-income families, especially those approaching retirement age, could see the largest dollar amount rises in premiums. He pointed out that changes in federal subsidies might lead to much higher bills for those in their 50s and early 60s, as insurers generally charge older individuals more than younger ones.
Low-income households could also feel the pinch, as even minor premium hikes can strain already tight budgets.
At the same time, the lowest-income Oregonians are largely protected from these changes. Those earning up to 138% of the federal poverty level ($21,000 annually for individuals and $43,000 for families of four) are eligible for benefits through the Oregon Health Plan.
Oregon has also introduced the OHP Bridge Plan, which offers Medicaid-like coverage to adults at 200% of the poverty level, costing about $30,000 for individuals and $62,400 for families of four. Currently, around 32,000 individuals are enrolled in this plan.
However, individuals just above that threshold will lose access to free or very affordable insurance due to the end of enhanced subsidies.
Bend resident Wendy Worthington, 55, shared her family’s struggles, highlighting that healthcare is more than just a number. She left her career as an educator to care for her husband after he suffered a stroke and was later diagnosed with a rare brain tumor.
Her family relies on her husband’s $7,000 monthly disability income, which places them above the Medicaid limit, yet they still face challenges with medical costs. Since he is under 65, he does not qualify for Medicare, which only covers him and not her or their children.
Currently, they pay about $1,400 monthly in premiums via subsidies; without them, the figure would skyrocket to $3,284, roughly half the family’s income.
“It keeps me up at night,” Worthington noted. “Healthcare shouldn’t take 50% of your income. It’s just insurance. This doesn’t cover out-of-pocket medical expenses.”
Worried about the impact on middle-income families facing disabilities or health issues, she remarked, “This could happen to anyone. We thought we’d work until 65, but a stroke and cancer changed everything.” She emphasized that dropping insurance isn’t an option for them; it’s truly a matter of life and death.
Why is this important to Oregon’s ACA market?
Rising insurance premiums affect not just individual families, but could also have broader consequences for the healthcare system. Sharma indicated that higher premiums might drive away younger and healthier individuals, which skews the insurance pool older and less healthy. This might lead insurers to raise prices further to accommodate those requiring more care.
This phenomenon, termed a “death spiral” among health insurance groups, could prompt insurers to reduce their networks, leaving some areas without coverage altogether. Rural regions, particularly vulnerable with fewer insurers, are at higher risk.
As the insured population decreases, uncompensated care may rise. Hospitals and clinics often bear the cost of unpaid bills, which ultimately burdens everyone else.
“Healthcare will be provided where it is funded,” Sharma said, suggesting that rural communities could suffer from limited insurance options while also dealing with financially strained hospitals.
Can Oregon State do anything to help?
Unless Congress extends the grant expansion, Oregon lacks the power to cushion the impending blow. Amy Coven, a spokesperson for the Oregon Health Insurance Marketplace, mentioned that state officials have explored options, such as state subsidies or federal waivers, but these haven’t proven viable under the current system.
This is partly because Oregon depends on the federal registration system, HealthCare.gov, and does not have the means to distribute its own subsidies. Securing funding for relief would also necessitate Congressional approval, something Coven views as “very unlikely” given the state’s constrained budget and competing demands for Medicaid, which also faces cuts.
There are also technical hurdles. Since Oregon doesn’t control HealthCare.gov, it lacks direct access to consumer data, complicating efforts to determine eligibility for assistance or issue payments quickly.
“Even if stopgap funding became available unexpectedly, Oregon would struggle to efficiently identify who qualifies or link them to those funds,” Coven explained. Given the timeline, there simply isn’t enough time to establish that infrastructure by year-end, she added.
What can Oregonians do now?
Those in Oregon looking to purchase Obamacare plans for next year can still manage rising costs during open enrollment. By comparing plans, they might opt for one with lower premiums. For instance, switching from a Silver to a Bronze plan generally yields lower monthly costs but higher deductibles.
For those starting coverage on January 1, the initial month’s premium is typically due in mid-December. State officials advise prompt payment to maintain coverage, even with ongoing Congressional deliberations regarding expanded subsidies.
If Congress does extend the enhanced credits, HealthCare.gov will automatically update the subsidy information and relay it to insurance companies. Though adjustments may take some time, the federal government’s provisions for grace periods should allow consumers adequate time to settle their January premiums without losing their plans.
The Oregon Health Authority has published a report to assist residents in comparing plans while outlining how expiring subsidies could influence their costs in 2026. Additionally, the state health insurance marketplace provides connections to local insurance agents for free guidance.
