Many American families could see their health insurance costs go way up next year. The special help from the Affordable Care Act, or ACA, might end soon. This could make premiums jump by hundreds of dollars each month. For some, like the Safford family, it means tough choices about money and health care.
Leighanne Safford and her husband Lorry now pay just $278 a month for their health plan. But starting January 1, that could rise to $1,800. That’s a huge increase! Their story shows what millions might face if Congress does not act.
The extra subsidies started in 2021 with the American Rescue Plan. They made ACA plans cheaper for middle-class folks. The Inflation Reduction Act kept them going until 2025. But this year, Republicans in Congress did not renew them in big spending bills. Now, it’s not clear if they will add them to a later bill to keep the government running.
For the Saffords, it’s even worse. New changes to Medicaid from President Trump’s big law this summer could cut coverage for their 13-year-old son, Adam. He now has Medicaid, but they worry he might lose it. So, the family plans to add him to their ACA plan in 2026. That makes costs even higher.
Safford says $1,800 is too much for just her and her husband. They might have to skip food or dental visits to pay it. Instead, they look at a cheaper high-deductible plan for the whole family. These plans have lower monthly payments but big out-of-pocket costs before insurance helps. It’s a risk, but they hope it works since they are all healthy now. “Health can change any day,” Safford said.
In 2025, over 24 million people use ACA insurance, says KFF, a health research group. More than 22 million get the extra subsidies. In states like Mississippi, Florida, and others, almost all ACA users get this help. New Hampshire and Washington have lower rates, around 70%.
If subsidies end, about 4 million people might drop coverage in 2026, says the Congressional Budget Office. That could grow to 7 million by 2034. “Millions will go uninsured,” said Edwin Park from Georgetown University. Without help, plans get too expensive.
A Double Hit for Families
Open enrollment for 2026 ACA plans starts November 1. But bad news comes in October with premium notices. Jessica Altman from Covered California says families will feel “sticker shock.” In her area, a family of four making $113,000 could pay $1,550 more a month without subsidies. With them, it’s just $112.
Insurers also plan to raise rates by about 18% next year, per KFF. Losing subsidies plus hikes means 75% higher premiums on average. Even those with basic ACA subsidies will pay more. Cynthia Cox from KFF says almost everyone buying their own insurance will feel it.
In Washington state, Dr. David Zonies sees patients at a hospital for low-income folks. He worries many will skip care and get sicker. “It could be like before the ACA,” he said. That’s bad news for health.
Will Congress Save the Day?
Lawmakers might still extend the subsidies in a spending bill by September 30. Democrats push hard for it. Many Republicans say no. But Senate leader John Thune and House Speaker Mike Johnson leave the door open a bit. Thune blames Democrats for making the program too big.
A KFF poll shows 3 in 4 adults want the subsidies to stay, including many Republicans. If extended, it might not be as good. Republicans could make them less generous.
Some families might cut spending to keep coverage. Others, like the Saffords, will pick high-deductible plans. These protect from huge bills, like for cancer or accidents, says Cox. Safford hopes for the best but fears the loss. “It would take away from our life,” she said.
This issue affects so many. States with high subsidy use, like the South, will hurt most. Families everywhere might choose between insurance and basics. Congress has time, but not much. An extension would give peace and keep health care affordable.
The Saffords’ story is real for many. They want to stay healthy and covered. But without help, it’s hard. Watch for news on what lawmakers do next. It could change lives for millions.
- Extra Subsidies Help Middle Class: Started in 2021, they made ACA plans cheap for families earning more.
- Expiration Looms: Set to end December 31, 2025, unless Congress acts.
- Big Premium Jumps: Families like Saffords could pay $1,500+ more monthly.
- Medicaid Cuts Add Pain: Trump’s law might drop kids like Adam from coverage.
- High-Deductible Option: Cheaper monthly but big costs if sick.
- Millions at Risk: 4 million could lose insurance in 2026.
- State Differences: Southern states rely most on subsidies.
- Insurer Hikes: 18% average increase planned for 2026.
- Public Support Strong: 75% of adults want extension.
- Congress in Spotlight: Funding bill deadline is September 30.
This fight shows how health care ties to money and politics. Families wait and hope for good news.
