Concerns Over Affordable Care Act Subsidies Loom as 2025 Approaches

Andy Lilienthal, a 47-year-old freelance journalist and marketer, finds himself among millions worried as the year draws to a close. He and his wife, both small business owners, currently pay around $660 monthly for their health insurance through the Affordable Care Act (ACA) subsidies. However, without the subsidy next year, that cost could skyrocket to nearly $1,700—more than their mortgage in Portland, Oregon.

“It has created a lot of uncertainty,” Lilienthal shared in a phone interview. “There’s definitely been an increase in anxiety and stress around here… It’s a pretty significant burden on everything right now.”

During a lengthy 43-day government shutdown, Democrats sought to include an extension of ACA subsidies in the spending package to reopen the government. Unfortunately, eight Democrats aligned with Republicans, ending what became a record shutdown. President Donald Trump ultimately signed a spending bill devoid of a health care package, a move that could leave millions without coverage and facing soaring costs in 2026. Nearly 24.3 million Americans rely on ACA plans, with about 92 percent receiving some kind of subsidy, as reported by the Centers for Medicare and Medicaid Services. The subsidies are set to expire in December, though some lawmakers are exploring options for a solution.

Like Lilienthal, others share his fears about losing ACA subsidies. A recent West Health/Gallup poll found that Americans are growing increasingly anxious about health care costs as 2026 approaches, more so than they were the previous year. This survey, conducted among roughly 20,000 individuals nationwide, found almost half of the respondents worried they might not afford their medical bills by 2026. Alarmingly, one in five adults reported someone in their household had skipped a prescription due to cost recently, while around 30 percent acknowledged a household member with health issues neglected treatment because of expenses.

Alaina Shearer, who owns a small advertising agency, told Salon that although she doesn’t receive ACA subsidies, she’s considering living without health insurance for the first time in her life. Her family of four’s plan is set to rise from $1,295 to $1,695 monthly in 2026, a plan that hardly covers anything substantial since the deductible is a staggering $20,000. She estimates spending an additional $400 each month on copays and prescriptions. Next year, the “better” plan she’s considering would cost around $2,300 monthly with a $7,000 deductible.

“I’ve been talking to my son’s local doctor about potentially paying out of pocket,” she mentioned, adding, “It’s terrifying to think about what would happen during an emergency or if one of us faced something serious, like cancer.” Shearer founded her business back in 2009 and recalls paying only $350 for her family’s health insurance back then.

“I can’t shake the feeling that I’m failing my family,” she expressed. “We’ve never gone without health insurance. Just considering it feels like a huge letdown. But I remind myself there’s a bigger picture here.”

The U.S. remains the sole high-income country without universal health coverage. While wealthier nations typically spend more on health care per capita than those with lower incomes, the U.S. spends significantly more yet has the lowest life expectancy among affluent countries.

Munira Z. Ganja, a senior fellow at the Commonwealth Fund’s International Learning and Exchange Program, spoke with Salon, explaining that healthcare costs in the U.S. are extremely high due to various factors.

“Hospital services can be outrageously priced,” she noted. “While insurance companies might offer numerous services, consumers often don’t see improvements in health outcomes.”

In 2023, approximately 8% of Americans lacked health insurance. Deborah Kevin, a 62-year-old small business owner based in Baltimore, expressed that living without insurance at her age isn’t really an option. However, she’s uncertain how to manage rising medical costs next year. Currently, she and her husband pay $365 monthly for Blue Cross/Blue Shield coverage, which has a $6,100 annual deductible. If the ACA subsidies disappear, their premiums could skyrocket to nearly $1,600 monthly in 2026.

“This rise prompts questions about what kind of care will actually be accessible,” Kevin remarked. “If something goes awry, do you lower coverage, risking higher out-of-pocket expenses? Or do you absorb the costs and trim your budget elsewhere?”

She mentioned that contemplating these financial strains has led to many sleepless nights.

“Running a company brings a unique kind of stress,” Kevin explained. “You’re shouldering every decision on how to care for your clients, team, family, and yourself. With the health insurance hike, that weight feels even heavier.”