MW More Americans are choosing Obamacare plans they can't afford in first look at ACA without enhanced tax credits
By Jaimy Lee
There is little likelihood that a fix will come from Washington, where Republican lawmakers say health insurers are to blame
Kate Bovina has relied on Obamacare for a decade. The 37-year-old classical violinist lives in Tempe, Ariz., and makes a living with a mix of part-time jobs, including teaching violin lessons and playing weddings.
Last year, she and her husband, who is also a self-employed musician, paid $118 for their monthly health-insurance premium. The plan had a $1,500 deductible, and their medications cost $3 at the most.
But now, the enhanced tax credits that lowered the cost of Affordable Care Act health plans have expired. As a result, millions of Americans who rely on Obamacare have had to make an impossible decision: go without health insurance, pay hundreds or even thousands of dollars more for the same plan, or downgrade their coverage.
The couple, who Bovina describes as healthy, downgraded to a Bronze plan. They now pay slightly more for their premium - about $157 per month - but the deductible jumped to $18,000 and the out-of-pocket maximum is about $20,000.
"If something happened and we went to the hospital, there's no way we could even afford close to that," she said. "We'd have to go into debt for probably years to pay that off."
This is the first enrollment period for ACA plans since the enhanced tax credits expired. Buying health insurance through the Obamacare marketplace is now significantly more expensive - with some people who previously benefitted from the tax credits finding that the costs of their premiums doubled.
Some states are extending enrollment to give people more time to figure out their coverage plans. But the people who run those marketplaces in several states told reporters this week that they are seeing a worrisome pattern: Not only are people downgrading their coverage, but they are bypassing midtier Silver plans for Bronze plans - which have hefty deductibles - or dropping health insurance altogether.
More than 70,000 people in Pennsylvania - about 15% of the total participants in the marketplace there - have canceled their ACA plans. In Maryland, which expanded a premium-assistance program to all of its ACA enrollees this year, consumers who had Gold plans with $1,000 deductibles in 2025 are downgrading to Bronze plans with $10,000 deductibles for 2026.
"People [are] truly wondering how it is that they are supposed to stay healthy and alive," Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, said during a media call.
What's happening now is a mix of penny-pinching and finger-pointing. The Americans who are still paying for health coverage now have to figure out where in their budgets they can find extra money. The leaders of several state marketplaces believe that there will be another wave of cancellations by April or May, once people realize just how costly the premiums are.
"While open enrollment in Idaho has ended, the full impact of affordability concerns will not be known for many months," said Pat Kelly, CEO of Idaho's marketplace.
So far, about 830,000 fewer people have enrolled in Obamacare plans in 2026, though the Centers for Medicare and Medicaid Services has not shared a final "snapshot" showing how many people enrolled in ACA plans this year. It's unclear if the agency will do so; it released last year's comparative update on Jan. 17, 2025.
The affordability of health insurance is an increasingly thorny issue for Republican lawmakers, many of whom have been critical of the ACA as a concept and the enhanced tax credits that lowered the costs of its plans. They have long claimed that Obamacare increases costs, limits access and lacks the kind of competition that lowers premiums - and they largely voted against extending the tax credits last month.
But with midterm elections coming later this year, some Republicans are now taking aim at health insurers, just as President Donald Trump has done in recent months.
"The [Trump] regime and their enablers have been using fraud as an excuse for a cruel agenda of cutting access to healthcare for millions of Americans and blaming insurers," Rep. Lloyd Doggett, a Texas Democrat, said Thursday during a congressional hearing.
Lawmakers put health insurers to the test this week. The CEOs of Cigna $(CI)$, CVS Health $(CVS)$, Elevance Health (ELV), UnitedHealth Group $(UNH)$ and Ascendiun, the parent company of the nonprofit Blue Cross Blue Shield of California, testified on Capitol Hill in back-to-back hearings on Thursday - first before a House of Representatives subcommittee and then before the House Ways and Means Committee.
In his testimony, UnitedHealth CEO Stephen Hemsley announced the company "will voluntarily eliminate and rebate our profits this year" for the ACA plans, while Cigna CEO David Cordani said his company is getting rid of drug rebates, which will reduce its earnings by "$500 to $600 million next year." However, investors didn't appear to be worried; shares of all four publicly traded companies closed higher on Thursday.
"Yes, insurers are more in the hot seat than they've been in a long time, and Republicans, who traditionally would defend the insurers, are now willing to have conversations about costs and affordability," said Raymond James analyst Chris Meekins. "But how you go about fixing this is hard to imagine."
President Trump - who has said he "might" veto legislation extending the credits - recently introduced his own healthcare agenda, which would give certain consumers cash in a health savings account that they could use to offset the rising cost of premiums. Trump has also said he wants to meet with health insurance CEOs, saying he "would be willing to bet, I think, that they would reduce their prices." No such meetings have yet been confirmed.
However, critics say $1,000 or $1,500 deposited in a HSA won't do much for someone who is paying $2,000 per month with 40% coinsurance and a $9,900 out-of-pocket maximum.
That's the situation facing Ellen Allen, executive director of West Virginians for Affordable Health Care, who also testified before House lawmakers. Allen said the cost of her premiums soared 320% from one year to the next. She used to pay about $500 a month for medical, vision and dental coverage under a Bronze plan. Now, it costs about $2,000 a month and no longer includes vision and dental coverage - meaning she'll pay about $16,000 in premiums alone this year until September, when she'll qualify for Medicare.
"There's nothing fair about a system that makes us choose between saving for retirement or dipping into our savings to pay for a procedure that is life-preserving," Allen said. "Or, as several people I know are doing, they're dropping their health insurance all together and rolling the dice."
-Jaimy Lee
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(END) Dow Jones Newswires
January 24, 2026 09:00 ET (14:00 GMT)
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