Health Care Anxiety: Uncertainty over ACA Subsidies Looms for Families

Wed Oct 22 2025 00:06:41 GMT+0300 (Eastern European Summer Time)

With potential changes to the Affordable Care Act's subsidy structure, many American families face the prospect of skyrocketing health insurance costs, which could lead to difficult choices about their health and finances.

As Congress deliberates on extending ACA subsidies, families like Celia and Jorge Monreal worry about the affordability of their current health insurance plan. If subsidies expire, coverage for millions could become significantly more expensive, leading to tough choices between necessary medical care and essential living expenses. Analysts stress the potential fallout could be felt well beyond individual households, affecting entire communities and healthcare systems.

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 healthcare 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 millions of Americans whose 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 over the last four years will expire this year unless Congress acts. On average, this would more than double the current premium costs for those subsidized.

No extension means higher premiums for millions

With over 24 million people insured through the ACA, including farmers and small business owners, the impending expiration of subsidies could dramatically affect their access to healthcare. Currently, these tax credits make healthcare affordable, allowing some lower-income enrollees to avoid premiums altogether.

If the tax credits expire, annual out-of-pocket premiums could rise by 114% or an average increase of $1,016 next year. While some tax credits will remain, many will face decreased support from these subsidies. This situation poses particular challenges for self-employed individuals who lack coverage through their jobs.

The lack of support may lead to an increase in uninsured individuals, straining hospital capacities as these populations seek urgent medical care they can't afford. Jason Levitis, a senior fellow in health policy, noted that less coverage could lead to sicker populations and ultimately higher healthcare costs in the long run.

Celia Monreal's family exemplifies the struggle many will face if policy changes occur without new support in place. With their husband facing significant health challenges and uncertainty lurking around their healthcare coverage, many families are left in a state of worry about how their needs will be met amidst changing political landscapes.