Millions of Americans, including 500,000 Ohioans who are buying health insurance through the Affordable Care Act, could see large increases in premiums in their plans starting in the new year. Congress has not yet voted to continue government subsidies for the ACA.
WOSU’s Debbie Holmes spoke with Brian O'Rourke, a healthcare policy analyst with the Health Policy Institute of Ohio. It's an organization designed to guide public and private policymakers with its research and analysis on how to achieve sustainable health care spending in the state.
Debbie Holmes: What are you seeing right now with premiums for next year?
Brian O’Rourke: So, in the Affordable Care Act marketplace, we've had enhanced premium tax credits or enhanced subsidies for the last handful of years, which have really made these plans more affordable for people who get their insurance through the marketplace, which includes groups like people who are self-employed and farmers and ranchers, amongst many others. What we're seeing is because of the expiration of those enhanced premium tax credits, along with general premium increases that are being proposed by insurance plans, people are going to see potentially doubling or more of their premiums going into 2026, which can amount to thousands of dollars for a lot of individuals and families.
Debbie Holmes: And with Congress not acting yet to keep those government subsidies, people are going to get a shock, right?
Brian O’Rourke: Yes, so if they're going on to healthcare.gov in Ohio to renew or look at a plan, they're going to see what those rates are for 2026. And so a lot of them have probably already seen that and are trying to make a decision of what to do because of those big premium increases. And some people probably also don't know yet, but will likely find out in the coming few weeks as open enrollment ends.
Debbie Holmes: There's some deadlines people need to be aware of.
Brian O’Rourke: Dec. 15 is the last day to enroll in the marketplace to start your coverage on Jan. 1. Open enrollment goes until Jan. 15th, although your coverage will start a little bit later if you enroll later. So, you could have a gap in coverage.
Debbie Holmes: How many folks in Ohio could go without insurance if it's too expensive for them?
Brian O’Rourke: Because of the enhanced premium tax price, we've seen enrollment rise pretty substantially in the last five years in Ohio. We have almost 600,000 people in Ohio using the marketplace. Some projections from the Urban Institute and others suggest that, you know, over 100,000, up to 140,000 individuals could become uninsured because of these premium increases and the expiration of the enhanced subsidies, mainly because people might feel like they just cannot afford to keep their plan and will, you know, choose to drop coverage.
Debbie Holmes: Have you heard what folks are saying?
Brian O’Rourke: You know, we will not know the numbers yet, in terms of exactly what people are deciding and how many people are going uninsured. That will kind of come out at the start of the new year or a little bit into the new year. But the expectation is that a lot of people are going to see those big rate increases of thousands of dollars in some cases, and they're going to decide that they just cannot afford it with their budgets and all the other cost of living constraints that many Ohioans are currently facing related to other life necessities. And so that will be a really difficult decision for some people that they're going to be facing in these coming weeks.
Debbie Holmes: How much do you think the ACA has helped Americans looking for economical health care premiums and out-of-pocket costs?
Brian O’Rourke: The marketplace, which was just one part of the Affordable Care Act, was developed to help those people who didn't have insurance offers through their employer and weren't eligible for a program like Medicaid or Medicare. So, it was a really important source of insurance. And enrollment wasn't that high. But when we did enact those enhanced subsidies starting in 2021, we did see across the country a lot more people choosing to take those ACA marketplace plans. And because of those enhanced subsidies, they were quite affordable for a pretty wide range of income levels. And so the concern now is with the expiration, really the sudden expiration of those enhanced subsidies at the end of this year, there's going to be kind of a spike, a very rapid spike in the prices that people see, which is kind of the big concern about how this is going to intersect with affordability and cost of living.
Debbie Holmes: What is your advice then for folks needing to buy a plan or wanting to?
Brian O’Rourke: It's still important to keep an eye on federal proceedings. There is still a chance that these enhanced subsidies are extended at the you know last minute, though that is seeming less and less likely as we go on. And otherwise, it's really to, you know, carefully consider your options, which is very dependent on your life context and budget. But you know, understanding that there are risks of going uninsured in terms of having, you know, a sudden or catastrophic medical event and being left potentially with, you know, really large medical bills if you do not have insurance. And so that's a really difficult decision that people are going to have to make.
