Impending Health Care Crisis as ACA Subsidies Loom Large for Millions

Thu Oct 16 2025 18:16:29 GMT+0300 (Eastern European Summer Time)

As the expiration of ACA tax credits threatens to spike health care costs, many Americans face difficult choices between medical care and daily expenses.

Celia Monreal worries about her husband's health and the potential increase in their health care costs due to the expiration of ACA tax credits. With government funding in gridlock and the open enrollment for health coverage approaching, millions of Americans could see their premiums soar, potentially leaving many without necessary healthcare services. The stakes are high for families like the Monreals, who struggle to choose between healthcare and basic necessities.

TYLER, Texas (RTW) — Celia Monreal has concerns every day regarding her husband ailing from cartilage loss in his knees. The pain she sees him in isn't her only concern; her thoughts drift towards the expected sharp rise in health care costs when their health insurance subsidies from the Affordable Care Act (ACA) potentially expire.

The Monreals, ages 47 and 57 respectively, lean on the ACA marketplace for their coverage. If Congress does not act to extend the expiring ACA tax credits, they anticipate their fully subsidized healthcare plan to increase beyond their financial reach. Without insurance, the couple cannot afford necessary knee surgeries or manage existing health issues, including chronic high blood pressure and high cholesterol.

“It pains me to think about it. Do I shell out $500 for a doctor’s visit or do I buy groceries?” Monreal questioned.

This dilemma reflects the situation of millions awaiting renewal of their health insurance plans come November. The enhanced tax credits that have significantly reduced health coverage costs for low- and middle-income earners are set to terminate unless Congress intervenes. According to KFF analysis, if the subsidies expire, the average premium paid by subsidized enrollees will more than double next year.

Higher Premiums Could Lead to More Uninsured

Over 24 million people rely on ACA health insurance, many of whom would see the cost burden shift dramatically. The enhanced tax credits have previously rendered healthcare affordable, allowing lower-income individuals to access zero-premium plans and limiting the costs for others to no more than 8.5% of their income.

Research estimates that without the tax credits, annual out-of-pocket premiums could surge by 114% on average, leaving many Americans struggling to maintain health insurance amid rising costs.

Should the subsidies lapse, the impact might ripple through the health system, prompting more uninsured people, leading to doctor visits and emergency care that they cannot afford. As coverage declines nationwide, hospitals could face closures, straining the healthcare system even further.

“Fewer subsidies mean less health coverage and care, resulting in worse health outcomes and increased mortality,” cautioned Jason Levitis from the Urban Institute.

Facing the Unknown

Erin Jackson-Hill, 56, is a caregiver with chronic asthma, and she too fears the potential loss of ACA subsidies next year will force her to relinquish her healthcare coverage altogether. “If I don’t manage my asthma, I may end up in financial ruin from emergency care,” she shared.

The stakes are significant for many such as freelance filmmaker Stan Clawson, who, despite being healthy overall, has ongoing medical expenses related to a paralysis condition he has dealt with since childhood. For Clawson, without the safety net of insurance, acquiring necessary supplies could run him as high as $1,400 monthly.

“It's hard to recognize the true cost of living with a disability without insurance,” asserted Clawson.

Consequences of Delayed Action

Health analysts express concern about the ripple effect the possible subsidy expiration may trigger. Even if Congress does take action, premium rates for next year are already projected to remain elevated due to uncertainty surrounding subsidy continuity. This might cause chaos and confusion among enrollees, many of whom anticipate higher costs ongoing.

As the Monreal family is left to contemplate the future three weeks before enrollment begins, they too feel the rising stakes. “They haven’t told us anything,” Monreal lamented about their insurer, “and, in the end, what if we end up with no health care?”