Lawmakers are once again locked in a familiar fight over the future of the Affordable Care Act. This time, however, the stalemate is unfolding during open enrollment, leaving millions of consumers uncertain about how much their health insurance will cost next year.
At issue are the enhanced federal subsidies that have helped lower premiums since the COVID-19 pandemic. Congress has yet to decide whether to extend them, even as consumers are required to select plans for 2025 coverage.
The delay is fueling anxiety among households and concern among state officials who oversee ACA marketplaces. It is also raising political stakes ahead of next year’s midterm elections.
A December poll by KFF found that roughly half of ACA enrollees who are registered voters said a $1,000 increase in total health care costs — including premiums, deductibles, and copays — would have a major influence on how they vote or which party they support.
For consumers, the consequences of inaction are clear. Without congressional action, premiums and out-of-pocket costs could rise sharply.
“Before I sign up, I will wait and see what happens,” said Daniela Perez, a 34-year-old education consultant in Chicago. She said her monthly premium could jump from about $180 to $1,200 if the subsidies expire. “I’m not super hopeful. It seems like everything is in gridlock.”
Congress has so far failed to reach agreement. In the Senate, a Dec. 11 vote to extend the subsidies fell short of the 60 votes needed for passage. An alternative Republican-backed proposal that included expanded health savings accounts also failed.
In the House, Speaker Mike Johnson is expected to bring forward a narrower health care package aimed at lowering costs through measures such as expanded association health plans, funding for cost-sharing reduction payments, and increased transparency requirements for pharmacy benefit managers. Like the Senate Republican proposal, it does not include an extension of the enhanced ACA subsidies.
Democrats broadly support extending the subsidies, which are set to expire at the end of the year. Republicans remain divided, with many objecting to the cost and to further strengthening the ACA. Some GOP lawmakers, however, worry that allowing the subsidies to lapse could trigger voter backlash.
The White House has not publicly endorsed a specific legislative approach.
Meanwhile, the clock is ticking. Consumers needed to enroll by Monday for coverage starting Jan. 1, though open enrollment continues in most states through Jan. 15 for plans beginning Feb. 1. State-run marketplaces are preparing contingency plans in case Congress acts late.
“We have a plan on the shelf,” said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, noting that updates to websites and consumer notices could take days or weeks.
Enrollment data already suggest signs of strain. Federal figures released Dec. 5 show new ACA enrollments running slightly below last year’s pace, while returning customers are enrolling earlier. Experts say that may reflect urgency among people with chronic conditions who cannot afford to go without coverage.
Some states report sharper drops. Pennsylvania saw a 16% decline in first-time enrollments in the early weeks of open enrollment, while California reported a 33% decrease through early December. In California, more consumers are choosing lower-cost bronze plans, which come with significantly higher deductibles.
“That people are being forced into plans with very high deductibles is a warning sign,” said Jessica Altman, executive director of Covered California.
If the enhanced subsidies expire, assistance would revert to pre-pandemic rules. Premium contributions would rise, and people earning more than four times the federal poverty level — $62,600 for an individual — would lose eligibility altogether.
For some families, the impact is dramatic. Debra Nweke, a retired 64-year-old in Southern California, said her household’s premium could increase from $1,000 to $2,400 a month. “How can you have health insurance that is more than your rent?” she said.
Even subsidized enrollees are feeling the squeeze. Andrew Schwarz, a 38-year-old preacher in Texas, said his monthly premium will rise from $40 to $150 next year. Still, he said, the ACA has worked for his family. “We’ll just have to take it out of somewhere else in the budget.”
As Congress debates, consumers are left waiting — and budgeting — amid uncertainty, with enrollment deadlines looming and no clear resolution in sight.
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