Dawn Wheeler has been closely following the developments surrounding the government shutdown. She expressed a sense of imminent danger regarding her situation.
The 59-year-old resident of Edwardsville, Kansas, is among the millions who rely on the Affordable Care Act Marketplace for health insurance. Her premiums may see a significant increase next year if Congress doesn’t prolong the COVID-era tax credits associated with the ACA.
Democratic lawmakers advocated for an extension of Obamacare subsidies to be included in the spending bill aimed at ending the government shutdown. However, on November 10, eight Senate Democrats sided with Republicans to bring a record 43-day shutdown to an end. Subsequently, the House passed the compromise, and President Donald Trump signed it into law, excluding the healthcare measures.
Now, advocates for patients warn that obtaining the necessary subsidies before year’s end could be a challenging task, given that premiums might more than double.
Senate Majority Leader John Thune (R-South Dakota) has pledged a December vote on a proposal to extend Obamacare subsidies, which assist millions of Americans in accessing healthcare. Meanwhile, House Speaker Mike Johnson has said he will not allow a similar vote in his chamber.
“If we couldn’t get that done during the shutdown, it’s hard to see what could change now,” commented Rebecca Karch, executive vice president at the National Patient Advocacy Foundation.
For Wheeler, who is battling metastatic breast cancer, the decision from Congress holds the potential for a financial impact of tens of thousands of dollars. Without the subsidy, her monthly premiums could escalate from $272 to a staggering $2,335 by 2026, consuming nearly 60% of her family’s income. After losing her job due to treatment, she now depends on her husband’s earnings.
Wheeler emphasized the critical nature of her insurance. She mentioned that one of her chemotherapy drugs costs around $20,000 monthly, and she usually reaches her out-of-pocket maximum by the beginning of each year.
Initially, Wheeler felt frustration towards Democrats for agreeing to a shutdown deal that overlooked ACA provisions.
“I really wish the Democrats had held out,” she remarked. “We’ll see how it unfolds, but I can’t shake the feeling that I’m on shaky ground.” Ultimately, she directed her frustration towards Republicans for not addressing the extension in the July spending package.
“We are real people with real lives and families,” Wheeler noted. “With rising property taxes, increasing utility bills, and soaring food prices, I feel a real pinch.”
Concerns Among Obamacare Users
The enhanced tax credits were initially established in 2021 to help people afford health insurance amid the COVID-19 crisis.
This plan broadened eligibility for subsidies in ACA plans to include individuals whose premiums exceed 8.5% of their household income, even if they earn above four times the federal poverty level.
According to KFF, enhanced subsidies have led to a more than twofold increase in enrollment over the past five years, especially in states like North Carolina, Florida, Georgia, and Texas. Estimates suggest that up to 22 million Americans could see their premiums spike by 114% if these tax credits are allowed to expire.
The Congressional Budget Office projects that without the extension, about 4 million individuals could become uninsured. Should the subsidies be approved, the federal deficit could increase by approximately $350 billion by 2035.
Sabrina Corlett, co-director at Georgetown University’s Center on Health Insurance Reform, mentioned that the price hikes are influenced by various factors. If these subsidies are not renewed, individuals will face higher proportions of their premiums. Additionally, insurers expect a decline in enrollment due to higher costs, leading to overall price increases.
“That’s why average premiums may be 20% to 30% higher,” Corlett stated. “This translates to a severe economic burden for millions of families.”
Others, like Robert Kastner from the University of Chicago, argue that inflation of the numbers around the ACA tax credit impacts has led to some exaggerated claims. He estimates that the number of potential uninsured Americans may be closer to 2 million, which, while significant, still points to complications ahead.
He believes that while ending these subsidies would indeed leave many without insurance, it may also target government spending more effectively towards those in the greatest need.
Who Will Feel the Impact?
Of the 24.3 million Americans enrolled in ACA plans, approximately 22 million, or about 92%, rely on some form of subsidy.
KFF notes that small business owners and employees at smaller firms lacking employer-sponsored insurance form a considerable portion of ACA marketplace users. This includes individuals such as farmers, real estate agents, and restaurant and retail workers.
Anthony Wright, executive director of Families USA, pointed out that with the ACA extension no longer attached to shutdown negotiations, it appears more challenging to secure its passage before premium increases kick in. Open enrollment began on November 1, and those who enroll in the ACA marketplace are already confronting stiff premiums.
Wright, while refraining from blaming Democrats for abandoning the ACA during the government negotiations, criticized Republicans for excluding this measure.
“It’s undeniable that this is a significant setback,” he noted. “This should have been a straightforward vote to avert massive premium hikes after an election focused on affordability.”
Recent polling indicates discontent among those depending on tax credits, with many feeling that Republicans benefited more from the shutdown negotiations. A notable portion of Democrats expressed that their party conceded too much.
Eric and Kari Kurland, both retirees who purchased ACA insurance after 2021 when subsidies made it viable, shared their concerns. In 2025, their monthly insurance cost was $513, but for 2026, they face a potential cost of $2,218.69—a staggering increase. They jittery about affording the new premiums with a combined income of around $80,000.
User-friendly options seem limited, forcing them to consider alternatives like state retirement health plans, which still represent a significant portion of their income.
“It provides some relief, I suppose, but the cost is still daunting,” Kurland reflected. “My frustration lies with the Democrats, as they seem to have given up the fight.”
What Lies Ahead for Tax Credits?
In a post on Truth Social dated November 18, Trump urged Congressional Republicans to avoid focusing on extending the enhanced ACA tax credits. The president expressed a preference for measures that would send financial support “directly to the people;” however, precise details remain unclear.
Sen. Bill Cassidy (R-Louisiana) has proposed substituting the ACA’s tax credits with health savings accounts funded partially from the expired credits, aligning with Trump’s preferred economic model. Those enrolling in lower-tier plans would receive contributions to their HSA accounts.
The intricacies of this plan are still being worked out, with Republicans aiming to draft and vote on it by mid-December to counter Democratic initiatives to prolong the ACA subsidies.
However, a deadlock persists between the two parties, with limited time remaining in the current congressional session.
As decisions loom closer, advocates like Wright are growing concerned. “With the enrollment period running until January 15, any delay could worsen the premium situation, impacting a lot of families,” he warned. “Prolonged inaction translates to more adverse outcomes for individuals and the healthcare landscape overall.”
