As the shutdown drags on, these people will lose if health care
subsidies expire
[October 17, 2025]
By ALI SWENSON and KENDRIA LAFLEUR
TYLER, Texas (AP) — Celia Monreal worries every day about the cartilage
loss in her husband’s knees. Not just because it's hard for her to see
him in pain but also because she knows soon their health care costs
could skyrocket.
Monreal, 47, and her husband, Jorge, 57, rely on the Affordable Care Act
marketplace for health coverage. If Congress doesn’t extend certain ACA
tax credits set to expire at the end of the year, their fully subsidized
plan will increase in cost, putting it out of reach. Without insurance,
they won’t be able to afford his expected knee replacement surgeries,
much less the treatment they need for other issues, like her chronic
high blood pressure and his high cholesterol.
“It worries me sometimes, because if you’re not healthy, then you’re not
here for your kids,” Monreal said. “It’s a difficult decision, because,
OK, do I spend $500 on a doctor’s visit or do I buy groceries?”
Those are the types of choices facing the millions of Americans whose
state or federal marketplace health insurance plans will be up for
renewal in November. The enhanced premium tax credits that have made
coverage more affordable for low- and middle-income enrollees for the
last four years will expire this year if Congress doesn't extend them.
On average, that will more than double what subsidized enrollees
currently pay for premiums next year, according to an analysis by health
care research nonprofit KFF.
The tax credits are at the heart of the federal government shutdown, in
its third week with no end in sight. Democrats have demanded the
subsidies be extended as part of any funding deal they sign, while
Republicans say they'll only negotiate on the issue once the government
is funded.
With Congress deadlocked and the open enrollment period for ACA plans
approaching on Nov. 1 in most states, Americans like Monreal are left to
navigate the unknown.
No extension will mean higher premiums for millions
More than 24 million people have ACA health insurance, a group including
farmers, ranchers, small business owners and other self-employed people
who don’t have other health insurance options through their work.
The enhanced premium tax credits set to expire this year have made costs
far more manageable for many of them, allowing some lower-income
enrollees to get health care with no premiums and higher earners to pay
no more than 8.5% of their income.
If the tax credits expire, annual out-of-pocket premiums are estimated
to increase by 114% — an average of $1,016 — next year, according to the
KFF analysis.
While some premium tax credits will remain, the level of support will
decrease for most enrollees. Anyone earning more than 400% of the
poverty level — or around $63,000 per year for a single person — won’t
be eligible for the remaining tax credits.
As a result, especially hard-hit groups will include a small number of
higher earners who'll have to pay a lot more without the extra subsidies
and a large number of lower earners who'll have to pay a small amount
more, said Cynthia Cox, a vice president and director of the ACA program
at KFF.
With higher premiums, some people will drop out of health insurance
altogether, Cox said. When many younger, healthier people inevitably
forgo coverage, insurance companies will increase costs for members of
the covered population to account for them being older and sicker.
The change may also strain hospitals, since more uninsured people will
need emergency care they can’t afford. That could lead to hospital
closures or cost increases.
“If you have less subsidies for people getting health insurance, you’re
going to have less health coverage and less health care,” said Jason
Levitis, a senior fellow in the health policy division at the Urban
Institute. “People are going to be sicker and die more.”
A caregiver braces for the worst. A filmmaker considers a new job
Erin Jackson-Hill has allergies, asthma and searing hip pain she’s
managing with prescribed medications until she can get a hip
replacement. But even with all those conditions, the 56-year-old in
Anchorage, Alaska, doesn’t think she can pay for health insurance next
year if the ACA subsidies aren’t extended.
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Local hair stylist Christine Meehan sits in front of her medication
while talking about the possible increase in her health insurance
fee at her home in Upper Chichester, Pa., Monday, Oct. 13, 2025. (AP
Photo/Tassanee Vejpongsa)
 The executive director of two
nonprofits, who also cares for her 89-year-old father full time,
already pays nearly $500 a month for her premiums. If the subsidies
disappear, she plans to forgo health insurance and pay for her
asthma and allergy medications out of pocket.
Jackson-Hill said she worries about what will happen if her hip
worsens and she can’t make it up the stairs in her father’s
two-story home without treatment.
“I will have to go to the emergency room, or I’ll have to go
bankrupt in order to pay for it,” she said.
Another ACA enrollee, Salt Lake City freelance filmmaker and adjunct
professor Stan Clawson, said he’ll find a way to pay for health
insurance next year — even if it means he must buy cheaper groceries
or get a new job that provides it.
Clawson, 49, has lived with paralysis below his abdomen since
falling while rock climbing when he was 20. He’s active and
generally healthy, but his spinal cord injury has resulted in
tendonitis in his shoulders and frequent urinary tract infections.
He also has to buy catheters to use every time he urinates — a cost
he said would add up to around $1,400 a month without insurance.
“I don’t think a lot of people realize how expensive it is to have a
disability,” Clawson said, adding that trying to live without health
insurance would be “financially devastating."
Chrissy Meehan, a hair stylist in Upper Chichester, Pennsylvania,
has a neck condition that may require surgery. She says if ACA
subsidies expire, she'll further delay the procedure.
The 51-year-old voted for Republican Donald Trump for president last
year, something she said she’s almost embarrassed about now that the
Republican-led government hasn’t renewed the subsidies that help her
afford her coverage through the state marketplace.
“I work hard, and I’m trying to survive and do it the right way and
pay my way,” Meehan said. “I don’t want free. I just want affordable
for my income.”
Even if Congress does extend, the delay could have consequences
Health policy analysts note that even if the subsidies are extended,
insurance rate hikes for 2026 are already higher because insurers
had to factor in their potential expiration when they set premium
prices earlier this year.
There are also concerns the delay will cause chaos, confusion and
stress for Americans, some of whom have already started receiving
notices that their premiums will skyrocket next year.
“Once those people say, ’Oh, wait, forget it, I’m out,’ it’s going
to be hard to get a lot of them back,” said the Urban Institute's
Levitis.
Monreal's husband will likely need both knees replaced, which will
force him to take time off his job filling concrete. On their
already tight $45,000 joint annual income, budgeting for themselves
and their five children will become that much harder.
The concern over their budget and the uncertainty over their health
care coverage send her thoughts into yet another worrisome spiral
with just two weeks until open enrollment begins.
“They haven’t told us nothing,” she said of her insurance provider.
“And you know what? At the end, you end up with no health care.”
___
Swenson reported from New York. Associated Press video journalist
Tassanee Vejpongsa contributed to this report.
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