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  • Five things to know about the Affordable Care Act enhanced subsidies

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    The cost of health insurance is set to surge for millions of Americans under the Affordable Care Act at the start of the new year without the extension of expanded tax credits.The expanded subsidies were at the center of the 42-day government shutdown that ended in November. Now just days away from the new year, premiums are set to increase without an extension or resolution from Congress.The Get the Facts Data Team analyzed and aggregated statistics to know ahead of the rise in premiums in the new year.Premiums could rise on average 114%Premiums would more than double if the tax subsidies were to expire, according to an analysis from KFF. In addition to the potential ending of the subsidies, insurance rates are projected to rise across marketplace plans and employer-provided insurance.A one-person household with an annual income of $25,000 – a little more than 1.5 times the federal poverty level – is estimated to go from paying a maximum $100 out of pocket annually to $1,168.They would pay a maximum of less than $98 a month — 10 times more than the previous payment of less than $9 a month.The interactive below shows how the maximum out-of-pocket rates for benchmark plans may change if expanded subsidies expire for one, two and four-person households at various incomes. Estimates were calculated using maximum out-of-pocket rates from KFF published by the IRS, along with 2025 federal poverty level data from the U.S. Department of Health and Human Services for the 48 contiguous states plus D.C.The tool is not intended to calculate an individual’s actual payments. Healthcare.gov and other state marketplaces are the best source for specific premium costs.People closer to retirement age or with higher incomes could see the largest impactOnce the expanded tax credits expire at the end of this year, the out-of-pocket maximums will increase across the board, and people making above four times the poverty level will become ineligible for any tax credits.More than 6.7% of those who were enrolled in ACA plans earned more than 400% of the federal poverty level, accounting for 1.6 million people. Once the subsidies expire, these enrollees would no longer qualify for the subsidies under the ACA.Also heavily impacted are people approaching retirement age. The age group with the highest enrollment in marketplace plans is ages 55 to 64, data shows.KFF estimated in March that about half the enrollees who would lose the tax credit upon expiration are between 50 and 64.Premiums for individuals closer to retirement age and making more than 400% of the federal poverty level would also increase more compared to younger enrollees. Take a 30-year-old, a 45-year-old, and a 60-year-old earning $62,756 in a single household – 401% of the poverty level.Without the tax credits, the 30-year-old would see a $110 jump in the monthly premium for a silver plan, according to KFF’s ACA Enhanced Premium Tax Credit calculator. The 60-year-old would see an $881-per-month increase without the enhanced subsidies.24 million people are enrolled in plans under the Affordable Care ActThe subsidies are utilized by about 92% of the 24 million people enrolled in marketplace plans under the ACA, according to data from the Centers for Medicare & Medicaid Services.These expanded credits allow households of different sizes and income levels to be capped with maximum out-of-pocket costs.From 2020 to 2025, enrollment more than doubled as a result of expanded tax credits in the American Rescue Plan Act in 2021, which increased the subsidies and lifted a cap that disqualified people making four times the poverty level or more from being eligible for the subsidies.Under 2025 guidelines for the 48 contiguous states and Washington, D.C., the federal poverty level is $15,650 for a one-person household. At 400%, it’s $62,600.Six states have more than tripled in ACA enrollees since 2020There was a widespread increase in enrollment across states in the past five years.The six states that have more than tripled in enrollees since 2020 are Georgia, Louisiana, Mississippi, Tennessee, Texas and West Virginia. There were 14 states that more than doubled in enrollment. Just three places — including Washington, D.C. — declined in enrollment, according to data from the Centers for Medicare and Medicaid Services.Expired subsidies take effect Jan. 1Even though new insurance premiums would take effect in the new year, a retroactive extension could be passed in 2026.However, it would be complicated and would continue to grow more complicated over time, according to KFF. More enrollees may drop insurance in the meantime. In a KFF survey, a quarter of enrollees indicated they would go without health insurance if the cost of current coverage doubled. About a third said they’d look for a lower premium plan.PHNjcmlwdCB0eXBlPSJ0ZXh0L2phdmFzY3JpcHQiPiFmdW5jdGlvbigpeyJ1c2Ugc3RyaWN0Ijt3aW5kb3cuYWRkRXZlbnRMaXN0ZW5lcigibWVzc2FnZSIsKGZ1bmN0aW9uKGUpe2lmKHZvaWQgMCE9PWUuZGF0YVsiZGF0YXdyYXBwZXItaGVpZ2h0Il0pe3ZhciB0PWRvY3VtZW50LnF1ZXJ5U2VsZWN0b3JBbGwoImlmcmFtZSIpO2Zvcih2YXIgYSBpbiBlLmRhdGFbImRhdGF3cmFwcGVyLWhlaWdodCJdKWZvcih2YXIgcj0wO3I8dC5sZW5ndGg7cisrKXtpZih0W3JdLmNvbnRlbnRXaW5kb3c9PT1lLnNvdXJjZSl0W3JdLnN0eWxlLmhlaWdodD1lLmRhdGFbImRhdGF3cmFwcGVyLWhlaWdodCJdW2FdKyJweCJ9fX0pKX0oKTs8L3NjcmlwdD4=

    WASHINGTON —

    The cost of health insurance is set to surge for millions of Americans under the Affordable Care Act at the start of the new year without the extension of expanded tax credits.

    The expanded subsidies were at the center of the 42-day government shutdown that ended in November. Now just days away from the new year, premiums are set to increase without an extension or resolution from Congress.

    The Get the Facts Data Team analyzed and aggregated statistics to know ahead of the rise in premiums in the new year.

    Premiums could rise on average 114%

    Premiums would more than double if the tax subsidies were to expire, according to an analysis from KFF.

    In addition to the potential ending of the subsidies, insurance rates are projected to rise across marketplace plans and employer-provided insurance.

    A one-person household with an annual income of $25,000 – a little more than 1.5 times the federal poverty level – is estimated to go from paying a maximum $100 out of pocket annually to $1,168.

    They would pay a maximum of less than $98 a month — 10 times more than the previous payment of less than $9 a month.

    The interactive below shows how the maximum out-of-pocket rates for benchmark plans may change if expanded subsidies expire for one, two and four-person households at various incomes. Estimates were calculated using maximum out-of-pocket rates from KFF published by the IRS, along with 2025 federal poverty level data from the U.S. Department of Health and Human Services for the 48 contiguous states plus D.C.

    The tool is not intended to calculate an individual’s actual payments. Healthcare.gov and other state marketplaces are the best source for specific premium costs.

    People closer to retirement age or with higher incomes could see the largest impact

    Once the expanded tax credits expire at the end of this year, the out-of-pocket maximums will increase across the board, and people making above four times the poverty level will become ineligible for any tax credits.

    More than 6.7% of those who were enrolled in ACA plans earned more than 400% of the federal poverty level, accounting for 1.6 million people. Once the subsidies expire, these enrollees would no longer qualify for the subsidies under the ACA.

    Also heavily impacted are people approaching retirement age. The age group with the highest enrollment in marketplace plans is ages 55 to 64, data shows.

    KFF estimated in March that about half the enrollees who would lose the tax credit upon expiration are between 50 and 64.

    Premiums for individuals closer to retirement age and making more than 400% of the federal poverty level would also increase more compared to younger enrollees. Take a 30-year-old, a 45-year-old, and a 60-year-old earning $62,756 in a single household – 401% of the poverty level.

    Without the tax credits, the 30-year-old would see a $110 jump in the monthly premium for a silver plan, according to KFF’s ACA Enhanced Premium Tax Credit calculator.

    The 60-year-old would see an $881-per-month increase without the enhanced subsidies.

    24 million people are enrolled in plans under the Affordable Care Act

    The subsidies are utilized by about 92% of the 24 million people enrolled in marketplace plans under the ACA, according to data from the Centers for Medicare & Medicaid Services.

    These expanded credits allow households of different sizes and income levels to be capped with maximum out-of-pocket costs.

    From 2020 to 2025, enrollment more than doubled as a result of expanded tax credits in the American Rescue Plan Act in 2021, which increased the subsidies and lifted a cap that disqualified people making four times the poverty level or more from being eligible for the subsidies.

    Under 2025 guidelines for the 48 contiguous states and Washington, D.C., the federal poverty level is $15,650 for a one-person household. At 400%, it’s $62,600.

    Six states have more than tripled in ACA enrollees since 2020

    There was a widespread increase in enrollment across states in the past five years.

    The six states that have more than tripled in enrollees since 2020 are Georgia, Louisiana, Mississippi, Tennessee, Texas and West Virginia. There were 14 states that more than doubled in enrollment.

    Just three places — including Washington, D.C. — declined in enrollment, according to data from the Centers for Medicare and Medicaid Services.

    Expired subsidies take effect Jan. 1

    Even though new insurance premiums would take effect in the new year, a retroactive extension could be passed in 2026.

    However, it would be complicated and would continue to grow more complicated over time, according to KFF.

    More enrollees may drop insurance in the meantime. In a KFF survey, a quarter of enrollees indicated they would go without health insurance if the cost of current coverage doubled. About a third said they’d look for a lower premium plan.

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  • Senate rejects extension of health care subsidies as costs are set to rise for millions of Americans

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    The Senate on Thursday rejected legislation to extend Affordable Care Act tax credits, essentially guaranteeing that millions of Americans will see a steep rise in costs at the beginning of the year.Senators rejected a Democratic bill to extend the subsidies for three years and a Republican alternative that would have created new health savings accounts — an unceremonious end to a monthslong effort by Democrats to prevent the COVID-19-era subsidies from expiring on Jan. 1.Ahead of the votes, Senate Democratic Leader Chuck Schumer of New York warned Republicans that if they did not vote to extend the tax credits, “there won’t be another chance to act,” before premiums rise for many people who buy insurance off the ACA marketplaces.”Let’s avert a disaster,” Schumer said. “The American people are watching.”Republicans have argued that Affordable Care Act plans are too expensive and need to be overhauled. The health savings accounts in the GOP bill would give money directly to consumers instead of to insurance companies, an idea that has been echoed by President Donald Trump. But Democrats immediately rejected the plan, saying that the accounts wouldn’t be enough to cover costs for most consumers.Some Republicans have pushed their colleagues to extend the credits, including Sen. Thom Tillis of North Carolina, who said they should vote for a short-term extension so they can find agreement on the issue next year. “It’s too complicated and too difficult to get done in the limited time that we have left,” Tillis said Wednesday.But despite the bipartisan desire to continue the credits, Republicans and Democrats have never engaged in meaningful or high-level negotiations on a solution, even after a small group of centrist Democrats struck a deal with Republicans last month to end the 43-day government shutdown in exchange for a vote on extending the ACA subsidies. Most Democratic lawmakers opposed the move as many Republicans made clear that they wanted the tax credits to expire.The deal raised hopes for bipartisan compromise on health care. But that quickly faded with a lack of any real bipartisan talks.The dueling Senate votes are the latest political messaging exercise in a Congress that has operated almost entirely on partisan terms, as Republicans pushed through a massive tax and spending cuts bill this summer using budget maneuvers that eliminated the need for Democratic votes. They also tweaked Senate rules to push past a Democratic blockade of all of Trump’s nominees. An intractable issueThe votes were also the latest failed salvo in the debate over the Affordable Care Act, President Barack Obama’s signature law that Democrats passed along party lines in 2010 to expand access to insurance coverage.Republicans have tried unsuccessfully since then to repeal or overhaul the law, arguing that health care is still too expensive. But they have struggled to find an alternative. In the meantime, Democrats have made the policy a central political issue in several elections, betting that the millions of people who buy health care on the government marketplaces want to keep their coverage.”When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen,” Schumer said in November, while making clear that Democrats would not seek compromise.Even if they view it as a political win, the failed votes are a loss for Democrats who demanded an extension of the benefits as they forced a government shutdown for six weeks in October and November — and for the millions of people facing premium increases on Jan. 1.Maine Sen. Angus King, an independent who caucuses with Democrats, said the group tried to negotiate with Republicans after the shutdown ended. But, he said, the talks became unproductive when Republicans demanded language adding new limits for abortion coverage that were a “red line” for Democrats. He said Republicans were going to “own these increases.”A plethora of plans, but little agreementRepublicans have used the looming expiration of the subsidies to renew their longstanding criticisms of the ACA, also called Obamacare, and to try, once more, to agree on what should be done.Thune announced earlier this week that the GOP conference had decided to vote on the bill led by Louisiana Sen. Bill Cassidy, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the chairman of the Senate Finance Committee, even as several Republican senators proposed alternate ideas.In the House, Speaker Mike Johnson, R-La., has promised a vote next week. Republicans weighed different options in a conference meeting on Wednesday, with no apparent consensus.Republican moderates in the House who could have competitive reelection bids next year are pushing Johnson to find a way to extend the subsidies. But more conservative members want to see the law overhauled.Rep. Kevin Kiley, R-Calif., has pushed for a temporary extension, which he said could be an opening to take further steps on health care.If they fail to act and health care costs go up, the approval rating for Congress “will get even lower,” Kiley said.___Associated Press writers Kevin Freking and Joey Cappelletti contributed to this report.

    WASHINGTON —

    The Senate on Thursday rejected legislation to extend Affordable Care Act tax credits, essentially guaranteeing that millions of Americans will see a steep rise in costs at the beginning of the year.

    Senators rejected a Democratic bill to extend the subsidies for three years and a Republican alternative that would have created new health savings accounts — an unceremonious end to a monthslong effort by Democrats to prevent the COVID-19-era subsidies from expiring on Jan. 1.

    Ahead of the votes, Senate Democratic Leader Chuck Schumer of New York warned Republicans that if they did not vote to extend the tax credits, “there won’t be another chance to act,” before premiums rise for many people who buy insurance off the ACA marketplaces.

    “Let’s avert a disaster,” Schumer said. “The American people are watching.”

    Republicans have argued that Affordable Care Act plans are too expensive and need to be overhauled. The health savings accounts in the GOP bill would give money directly to consumers instead of to insurance companies, an idea that has been echoed by President Donald Trump. But Democrats immediately rejected the plan, saying that the accounts wouldn’t be enough to cover costs for most consumers.

    Some Republicans have pushed their colleagues to extend the credits, including Sen. Thom Tillis of North Carolina, who said they should vote for a short-term extension so they can find agreement on the issue next year. “It’s too complicated and too difficult to get done in the limited time that we have left,” Tillis said Wednesday.

    But despite the bipartisan desire to continue the credits, Republicans and Democrats have never engaged in meaningful or high-level negotiations on a solution, even after a small group of centrist Democrats struck a deal with Republicans last month to end the 43-day government shutdown in exchange for a vote on extending the ACA subsidies. Most Democratic lawmakers opposed the move as many Republicans made clear that they wanted the tax credits to expire.

    The deal raised hopes for bipartisan compromise on health care. But that quickly faded with a lack of any real bipartisan talks.

    The dueling Senate votes are the latest political messaging exercise in a Congress that has operated almost entirely on partisan terms, as Republicans pushed through a massive tax and spending cuts bill this summer using budget maneuvers that eliminated the need for Democratic votes. They also tweaked Senate rules to push past a Democratic blockade of all of Trump’s nominees.

    An intractable issue

    The votes were also the latest failed salvo in the debate over the Affordable Care Act, President Barack Obama’s signature law that Democrats passed along party lines in 2010 to expand access to insurance coverage.

    Republicans have tried unsuccessfully since then to repeal or overhaul the law, arguing that health care is still too expensive. But they have struggled to find an alternative. In the meantime, Democrats have made the policy a central political issue in several elections, betting that the millions of people who buy health care on the government marketplaces want to keep their coverage.

    “When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen,” Schumer said in November, while making clear that Democrats would not seek compromise.

    Even if they view it as a political win, the failed votes are a loss for Democrats who demanded an extension of the benefits as they forced a government shutdown for six weeks in October and November — and for the millions of people facing premium increases on Jan. 1.

    Maine Sen. Angus King, an independent who caucuses with Democrats, said the group tried to negotiate with Republicans after the shutdown ended. But, he said, the talks became unproductive when Republicans demanded language adding new limits for abortion coverage that were a “red line” for Democrats. He said Republicans were going to “own these increases.”

    A plethora of plans, but little agreement

    Republicans have used the looming expiration of the subsidies to renew their longstanding criticisms of the ACA, also called Obamacare, and to try, once more, to agree on what should be done.

    Thune announced earlier this week that the GOP conference had decided to vote on the bill led by Louisiana Sen. Bill Cassidy, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the chairman of the Senate Finance Committee, even as several Republican senators proposed alternate ideas.

    In the House, Speaker Mike Johnson, R-La., has promised a vote next week. Republicans weighed different options in a conference meeting on Wednesday, with no apparent consensus.

    Republican moderates in the House who could have competitive reelection bids next year are pushing Johnson to find a way to extend the subsidies. But more conservative members want to see the law overhauled.

    Rep. Kevin Kiley, R-Calif., has pushed for a temporary extension, which he said could be an opening to take further steps on health care.

    If they fail to act and health care costs go up, the approval rating for Congress “will get even lower,” Kiley said.

    ___

    Associated Press writers Kevin Freking and Joey Cappelletti contributed to this report.

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  • State insurance commissioner says companies are delaying policies, denying discounts

    State insurance commissioner says companies are delaying policies, denying discounts

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    Responding to consumer complaints about auto insurance coverage, the state insurance commissioner said Thursday that insurers could face penalties for creating unlawful barriers for California drivers.

    Ricardo Lara issued a bulletin to auto insurers, reminding them that they cannot change their policies’ terms and rates without formally filing for state review and approval. The bulletin also reminded companies that they must offer coverage to all motorists in California who meet the state’s legal definition of “Good Drivers.”

    “These alleged passive-aggressive tactics by insurance companies to slow down drivers’ access to coverage are unacceptable, dangerous, and will not be tolerated,” Lara said in a statement. “I am taking action today to ensure these insurance companies are acting according to the law and giving drivers the coverage they are paying for at the rate they qualify for. We will continue to monitor the situation and take any and all steps necessary to protect California consumers.”

    The commissioner acted in response to numerous complaints the department received about insurers imposing requirements that are not allowed by state law, including Proposition 103, the 1988 ballot measure that regulated property and casualty insurance sold in California. Issuing the bulletin, the department said, makes the legal requirements clear to insurers and “sets the stage for future enforcement actions, if warranted.”

    Frustrated by state regulations, a number of insurers have limited the new policies their agents can sell in California. And for California drivers who already have policies, the challenge for many has been a sharp increase in premiums when they renew.

    California drivers are now running into speed bumps to coverage because insurers say they were hurt by Lara’s pandemic-related orders, including those requiring partial refunds to policyholders who were driving less and denying approval for rate increases through most of 2022.

    Big-name insurers have been saying for months that they “can’t get the rates they need from the state Department of Insurance,” said Mike D’Arelli, executive director of American Agents Alliance, a national association of independent insurance agents and brokers.

    The companies complained they were losing money despite being profitable as recently as 2022, according to Department of Insurance market share data.

    The complaints that reached Lara’s desk include claims that some auto insurers may not be offering “Good Driver” discounts to those who qualify. According to the department, California law requires insurers to offer a policy with such a discount to any driver who’s held a license for the last three years, has no more than one point on their driving record and was not principally at fault in a motor vehicle accident that resulted in bodily injury or death.

    Consumers also have complained about “having to complete unnecessarily lengthy and/or confusing questionnaires, verify employment or school information, respond to physically mailed questionnaires despite applicants electing to receive documents electronically, provide information regarding excluded drivers living at the same address, and/or submit copies of applicants’ utility bills, vehicle registrations, and/or photos of driver’s licenses or vehicles, among other examples,” the department said Thursday.

    These barriers in many cases “discourage, inhibit or delay” motorists from completing an application for insurance, especially in a timely manner, the department said.

    In addition to the requirement to offer coverage to good drivers, the bulletin issued by Lara highlights the limits on what insurers can demand from applicants. “The Insurance Commissioner may initiate administrative enforcement actions and/or seek penalties against any and all insurers failing to offer and sell automobile insurance to all qualified Good Drivers,” the bulletin states.

    The bulletin also reiterates that, under Proposition 103, auto insurers in California are required to submit complete rate applications to the insurance commissioner for review and approval “any time they seek to implement new, or changes to existing, programs, coverages, rates, rating factors, underwriting guidelines, rating rules, forms, and fees, or make any other changes that may have a rate impact,” even if they think there won’t be any impact, according to the Department of Insurance.

    “An insurer’s failure to file proposed underwriting guidelines prior to implementing the proposed guideline may result in an administrative enforcement action against the insurer leading to restitution and/or penalties,” the bulletin says.

    Proposition 103 gave the insurance commissioner the power to review property and casualty insurance premiums before they go into effect, known as a “prior approval” system. It also sharply limited the factors insurers could consider when setting rates, requiring that they show data connecting each factor to their risk of loss. The goal was to prevent insurers from setting discriminatory premiums that didn’t reflect a driver’s potential for claims. Prior to the law, insurance companies weren’t regulated.

    If a requested premium increase exceeds 7%, the commissioner makes an independent determination of the allowable rate change based on data provided by the insurance company. Proposition 103 also allows consumer advocates and other third parties to intervene with their own analyses and arguments.

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    Karen Garcia

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