Eleanor Walsh and her husband will see an increase of approximately $14,300 in their health insurance in 2026 as the Affordable Care Act subsidies sunset.
Walsh, who lives in St. John, said in 2025 they paid approximately $9,100 for health insurance, and in 2026 it will increase to $23,400. To save money, they decided to switch to a different insurance plan, she said.
In November, her husband had open-heart surgery to fix an aortic valve, Walsh said. While they used insurance for the operation, they still have more than $10,000 in medical debt, she said.
“And then we get hit with this huge increase. If we would have stayed with the same policy … it would’ve cost us a little over $27,700 for the year,” Walsh, 63, said. “We actually considered — at least for me — not to have insurance until Medicare (at 65), but then my husband said, ‘We’ll be in further medical debt if something major happens to you.’”
The Walshes are both self-employed, so they don’t have employer-sponsored insurance. For 2026, their total income will be about $100,000 and their expenses will be about $88,000, excluding food and clothing, Walsh said.
A further stress for 2026 is that under their new insurance plan, they have to account for a $10,130 deductible — for each of them — before insurance pays, Walsh said.
“We’re going through every expense we have,” Walsh said. “It’s going to be a rough year.”
The enhanced Affordable Care Act tax credits, which made coverage more affordable for low- and middle-income enrollees over the last four years, occurred when the subsidies weren’t renewed as part of the Republican-backed tax cut bill in July.
On average, the expiration will more than double what subsidized enrollees currently pay for premiums next year, according to an analysis by health care research nonprofit Kaiser Family Foundation.
The tax credits were at the heart of the most recent government shutdown. Democrats demanded the subsidies be extended as part of any funding deal they sign, while Republicans said they’d only negotiate on the issue once the government is funded.
More than 24 million people have ACA health insurance, a group including farmers, ranchers, small business owners and other self-employed people who don’t have other health insurance options through their work.
The enhanced premium tax credits have made costs far more manageable for many of them, allowing some lower-income enrollees to get health care with no premiums and higher earners to pay no more than 8.5% of their income.
When the tax credits expire, annual out-of-pocket premiums are estimated to increase by 114% — an average of $1,016 — next year, according to the KFF analysis.
While some premium tax credits will remain, the level of support will decrease for most enrollees. Anyone earning more than 400% of the poverty level — or around $63,000 per year for a single person — won’t be eligible for the remaining tax credits.
Insurance companies announced in June an increase in premiums for the ACA marketplace plans in 2026, which added extra attention on the COVID-19 era subsidies ending, said Kosali Simon, a distinguished professor in the Paul O’Neill School of Public and Environmental Affairs at Indiana University Bloomington.
“Health care costs have just increased so much in the way that insurers are charging for the marketplace that’s kind of driven where the political discourse has really focused more recently,” Simon said. “That, combined with the expiration of the extra COVID emergency provision, is where we are at right now.”
What’s important to remember, Simon said, is that while it’s awful to lose the subsidies, the Affordable Care Act still covers a majority of healthcare costs. Under the Affordable Care Act, the government pays an average of 83% of medical expenses, she said.
Under the COVID-era subsidy, the government paid an extra 5%, or 87% total, of medical costs under the Affordable Care Act, Simon said.
“While that means a big change … we have to keep remembering that the amount that the government still is picking up of the insurers tab is huge,” Simon said. “We shouldn’t lose sight of the fact that the Affordable Care Act still protects us a lot from what insurers are charging.”
The subsidy did benefit higher-income earners, like those making up to $120,000 like the Walsh family, and without the subsidy, those higher earners will lose a major benefit that isn’t granted under the original Affordable Care Act, Simon said.
The Affordable Care Act does a good job of protecting people at and near the poverty level, Simon said.
When comparing 2025 to 2026 insurance costs, Simon said the cost increase comes from the insurers raising premiums and the end of the subsidy.
“The government is saying, ‘Hey, remember, I’m going back to what the original ACA was, and I’m doing it at a time when insurers are charging base premiums,’” Simon said.
Walsh said the subsidy helped her and her husband stay afloat.
“It’s not like we’re milking the system for something so that we can spend money lavishly elsewhere. We needed that subsidy to help us get through our life on a very basic level,” Walsh said.
To help with the increase in insurance payments, Walsh said she’s considering pulling from her Social Security when she’s 64 years old. But, she said that’s a bittersweet decision because if she could wait until she’s 67, she’d receive a higher Social Security payment.
Walsh said pulling from Social Security, which she can do in June when she turns 64, won’t help with paying for the more than $10,000 medical debt.
“It would basically cover the increase in our insurance,” Walsh said. “I feel resentful that I have to even consider that because I’d rather wait 3 years and get more money than be forced into a situation where I have to take my Social Security early to pay for my health insurance.”
Her son is getting married in Colorado in 2026, Walsh said, and she’s anxious about the costs associated with the wedding.
“I try not to get emotional about it, but I am,” Walsh said. “You don’t want to be asking for help in this stage of your life, and you shouldn’t have to be because of health insurance.”
When the Affordable Care Act was first introduced, Walsh said it helped her family a lot. While she doesn’t have an answer for how to address health insurance and healthcare costs, Walsh said those costs have to come down somehow.
“I don’t believe people should be going bankrupt because of medical debt,” Walsh said.
The Associated Press contributed.
akukulka@post-trib.com
