Lethe200
Senior Member
- Location
- San Francisco Bay Area
I’ve covered Obamacare for years. Here’s who should be worried as enrollment starts.
Healthcare.gov open enrollment begins Saturday with premiums rising and enhanced subsidies set to expire. But not all Americans are being hit equally.
Washington Post November 1, 2025
Analysis by Paige Winfield Cunningham
Healthcare.gov and most state-run marketplaces open Saturday for Americans to buy 2026 health insurance plans. Unlike in recent years, this open enrollment is much more politically fraught as some Americans face soaring costs and Congress remains deadlocked over how to respond.
As a health care reporter, I’ve covered the Affordable Care Act since the insurance marketplaces it created launched in 2014. The law has been at the center of so many political fights, and once again I’m being bombarded with panicky press releases. And I’m seeing a lot of misconceptions about what all this means for consumers.
Congressional Democrats have pitched an epic battle — leading to a weeks-long government shutdown — over extending extra government subsidies that lowered people’s monthly premium contributions the past four years. Those extra subsidies are set to run out Dec. 31, which means 24 million marketplace customers will have to pay more next year — some, significantly more — to stay on their insurance plans.
The Affordable Care Act allows people who do not receive coverage through a government program or their employer to buy health plans on government websites, comparing costs and benefits and receiving subsidies based on their income. Insurance remained expensive for many until Congress enhanced those subsidies during the covid pandemic. As a result, enrollment through those marketplaces doubled in the past five years.
Democrats, health care advocates and major insurers argue that allowing these extra subsidies to expire will reverse enormous gains in the marketplaces. Facing spiking costs, people will just drop off insurance and start using the emergency room for care, they say.
Republicans — who have long blasted the Affordable Care Act but never managed to fully repeal it — say the extra subsidies were a temporary measure intended to help people during the pandemic. They say they are just trying to return to the original design of the Democratic health care law.
Even if the subsidies are extended, insurance plans have still become more expensive. And much of that cost will be borne by the federal government as it subsidizes those plans.
The average benchmark monthly premium is spiking about 26 percent to $625 nationwide. That’s the second-biggest premium increase in the marketplace’s 12-year history. In 2020, the average benchmark premium was $462.
This week, I’ve been talking to consumers across the country about what they are seeing when they window-shop on the marketplaces. Some think all the subsidies are disappearing.
Let’s address two key points getting lost amid all the noise:
1. Most people with low incomes are still heavily subsidized
The vast majority of people will still get subsidies, and there are limits on how much of their annual income they can spend on a plan.
To illustrate this, let’s rewind to 2020 — before the extra subsidies started — using a cost calculator by KFF, a nonpartisan health policy group, as a guide.
A person earning $22,000 annually could buy a subsidized, silver-level plan for $63 a month. Next year, it would cost $80.
Say this person’s earnings increase to $45,000. In 2020, they could get a silver plan for $303 a month. Next year, it would cost $387.
This is a point the Trump administration is stressing: Americans with low to middle incomes are not the ones hit with eye-popping price hikes. The Centers for Medicare and Medicaid Services said this week that the average marketplace premium for those eligible for subsidies will be $50 for the lowest-cost plan.
“There can be a lot of hair-pulling and mudslinging, but … that’s not the issue,” CMS Administrator Mehmet Oz told reporters this week. “The big issue is the fundamental flaws within the ACA.”
Oz was referring to how the law has not curbed the overall cost of health insurance, which continues to go up. While the ACA dramatically expanded insurance access to millions of Americans, it relied primarily on government spending to help people get coverage rather than making health care less expensive.
Insurers are partially blaming the expiration of extra subsidies for the rise in monthly premiums because they expect healthy people who are cheaper to insure to drop coverage. But they also blame other factors, such as the rising costs of care and pharmaceuticals.
And premium spikes lead us to our next point.
2. It’s higher-income enrollees facing massive sticker shock
Starting next year, people earning more than 400 percent of the federal poverty level (that’s about $62,000 for a single person, $84,000 for a couple and $129,000 for a family of four) will have to pay their whole premium, no matter how high it spikes. This is what’s known as the “subsidy cliff.”
While the law caps what share of incomes lower-income earners pay for health premiums, there is no limit for this higher-income group. Congress gave them a temporary cushion by capping their premium spending at 8.5 percent of income.
But people in this group could see enormous strains on their personal finances as the cap ends in 2026. They have lost all protection against premium increases. I talked to people this week whose monthly premium payments will double or even triple if they stay on their plan. Many of them are in their 50s and early 60s and are seeing some of the highest premiums because insurers can charge older people more.
This year, with the extra subsidies, a 60-year-old in this income category could get a silver plan for about $445 a month. But next year, when the subsidies are gone, they’d need to pay the full $1,326 premium, according to the KFF calculator. That might not be a big deal for someone who is wealthy. But for someone who earns less than six figures, that kind of cost could sharply strain their personal finances.
Healthcare.gov open enrollment begins Saturday with premiums rising and enhanced subsidies set to expire. But not all Americans are being hit equally.
Washington Post November 1, 2025
Analysis by Paige Winfield Cunningham
Healthcare.gov and most state-run marketplaces open Saturday for Americans to buy 2026 health insurance plans. Unlike in recent years, this open enrollment is much more politically fraught as some Americans face soaring costs and Congress remains deadlocked over how to respond.
As a health care reporter, I’ve covered the Affordable Care Act since the insurance marketplaces it created launched in 2014. The law has been at the center of so many political fights, and once again I’m being bombarded with panicky press releases. And I’m seeing a lot of misconceptions about what all this means for consumers.
Congressional Democrats have pitched an epic battle — leading to a weeks-long government shutdown — over extending extra government subsidies that lowered people’s monthly premium contributions the past four years. Those extra subsidies are set to run out Dec. 31, which means 24 million marketplace customers will have to pay more next year — some, significantly more — to stay on their insurance plans.
The Affordable Care Act allows people who do not receive coverage through a government program or their employer to buy health plans on government websites, comparing costs and benefits and receiving subsidies based on their income. Insurance remained expensive for many until Congress enhanced those subsidies during the covid pandemic. As a result, enrollment through those marketplaces doubled in the past five years.
Democrats, health care advocates and major insurers argue that allowing these extra subsidies to expire will reverse enormous gains in the marketplaces. Facing spiking costs, people will just drop off insurance and start using the emergency room for care, they say.
Republicans — who have long blasted the Affordable Care Act but never managed to fully repeal it — say the extra subsidies were a temporary measure intended to help people during the pandemic. They say they are just trying to return to the original design of the Democratic health care law.
Even if the subsidies are extended, insurance plans have still become more expensive. And much of that cost will be borne by the federal government as it subsidizes those plans.
The average benchmark monthly premium is spiking about 26 percent to $625 nationwide. That’s the second-biggest premium increase in the marketplace’s 12-year history. In 2020, the average benchmark premium was $462.
This week, I’ve been talking to consumers across the country about what they are seeing when they window-shop on the marketplaces. Some think all the subsidies are disappearing.
Let’s address two key points getting lost amid all the noise:
1. Most people with low incomes are still heavily subsidized
The vast majority of people will still get subsidies, and there are limits on how much of their annual income they can spend on a plan.
To illustrate this, let’s rewind to 2020 — before the extra subsidies started — using a cost calculator by KFF, a nonpartisan health policy group, as a guide.
A person earning $22,000 annually could buy a subsidized, silver-level plan for $63 a month. Next year, it would cost $80.
Say this person’s earnings increase to $45,000. In 2020, they could get a silver plan for $303 a month. Next year, it would cost $387.
This is a point the Trump administration is stressing: Americans with low to middle incomes are not the ones hit with eye-popping price hikes. The Centers for Medicare and Medicaid Services said this week that the average marketplace premium for those eligible for subsidies will be $50 for the lowest-cost plan.
“There can be a lot of hair-pulling and mudslinging, but … that’s not the issue,” CMS Administrator Mehmet Oz told reporters this week. “The big issue is the fundamental flaws within the ACA.”
Oz was referring to how the law has not curbed the overall cost of health insurance, which continues to go up. While the ACA dramatically expanded insurance access to millions of Americans, it relied primarily on government spending to help people get coverage rather than making health care less expensive.
Insurers are partially blaming the expiration of extra subsidies for the rise in monthly premiums because they expect healthy people who are cheaper to insure to drop coverage. But they also blame other factors, such as the rising costs of care and pharmaceuticals.
And premium spikes lead us to our next point.
2. It’s higher-income enrollees facing massive sticker shock
Starting next year, people earning more than 400 percent of the federal poverty level (that’s about $62,000 for a single person, $84,000 for a couple and $129,000 for a family of four) will have to pay their whole premium, no matter how high it spikes. This is what’s known as the “subsidy cliff.”
While the law caps what share of incomes lower-income earners pay for health premiums, there is no limit for this higher-income group. Congress gave them a temporary cushion by capping their premium spending at 8.5 percent of income.
But people in this group could see enormous strains on their personal finances as the cap ends in 2026. They have lost all protection against premium increases. I talked to people this week whose monthly premium payments will double or even triple if they stay on their plan. Many of them are in their 50s and early 60s and are seeing some of the highest premiums because insurers can charge older people more.
This year, with the extra subsidies, a 60-year-old in this income category could get a silver plan for about $445 a month. But next year, when the subsidies are gone, they’d need to pay the full $1,326 premium, according to the KFF calculator. That might not be a big deal for someone who is wealthy. But for someone who earns less than six figures, that kind of cost could sharply strain their personal finances.
