As ACA subsidies expire, people brace for higher costs

There are a lot of unknowns in the health insurance world with supplemental Affordable Care Act subsidies expired at the end of December. For now, at least, most ACA customers are facing spikes in their monthly premiums, causing them to seek alternative plans or forego coverage entirely. 

With the U.S. House in recess until January 6, Congress faces a tight deadline to fund the government by January 30, with previous contention over the subsidies responsible for the record 43-day government shutdown that started in October 2025. 

“I wonder why a decision (on the subsidies) hasn’t been made yet, because this is super important to a lot of people. I can’t imagine that they’re going to not extend the credits because of the consequences of doing that,” said Darcy Robertson, CFO at North Big Horn Hospital.

Wyoming’s U.S. Senators John Barrasso and Cynthia Lummis both opposed subsidy extensions during a Republican-Democrat duel toward the end of last session that ended in both parties’ proposed healthcare bills failing. Now the issue will head to the House, with Democrats seeking a three-year extension and Republicans suggesting health savings accounts be established to help people who purchase marketplace insurance pay out-of-pocket expenses. 

Brent Reasch, longtime owner and pharmacist at Lovell Drug, has reached out to Wyoming’s representatives with concerns about how his customers will be impacted by the subsidies ending. So far, he hasn’t heard back.

 “That’s the problem. Just getting rid of it, they don’t have any answers or any solutions themselves. So that’s why it’s just sitting where it’s at, and now the insurance companies basically have the say of what’s going on,” Reasch said.

Wyomingites face some of the steepest hikes in premiums without an extension. About 45,000 people in the state buy their insurance on the ACA marketplace. KFF, an independent health policy research and polling nonprofit, estimated that a 60-year-old Wyoming resident earning about $63,000 could face a 421% increase in their monthly premium on the marketplace. Higher premiums, deductibles and co-pays are anticipated, and with Mountain Health Co-op pulling out of Wyoming, the state is down to just two providers.

Craig Jones, the owner and pharmacist at Basin Pharmacy, estimated that 15% to 20% of his customers use marketplace insurance. The uninsured rate for his customers has previously sat around 10%, consisting mostly of people who fall into the gap of those who make too much for Medicaid, are too young for Medicare and find a private insurance policy too expensive. 

“Every year health insurance goes up, whether it’s the amount of the premium or the amount of the deductible or an increasing copay amount,” Jones said. “For the most part, it’s been more gradual. Every first of the year we get a load of complaints about it from customers. But I don’t recall a dramatic spike in the 20 years I’ve owned and run the pharmacy here.”

Reasch predicted more uninsured customers in the coming year and shared that about four customers in the past two weeks have come to him with concerns about their insurance costs. One customer with a pre-existing condition reported that the monthly premium for him and his wife would jump from $300 a month to $3,000.

“It’s pretty frustrating. They come in to see if we have any answers; we really don’t,” Reasch said. 

Greybull Dental’s Dr. Sam Davidson noted that ACA subsidies have not applied to dental insurance, and while their expiration may raise some costs for privately insured patients, Wyoming Medicaid benefits will remain unaffected.

“The larger issue in dental insurance is that annual benefit maximums have remained largely unchanged for decades. In the 1980s and 1990s, typical maximums were around $1,000 to $1,500, and in 2025 many plans still cap benefits at $1,500. As a result, patients pay more in premiums each year while receiving less real value due to inflation,” Dr. Davidson said in a statement. “In my opinion, any dental premium increases at this time would reflect insurers taking advantage of uncertainty created by the loss of ACA subsidies to increase their bottom line, rather than a true change in dental coverage costs.”

Without the subsidies, the original healthcare protections and regulations from the 2010 ACA will remain in place; only enhanced subsidies as part of a Biden administration COVID relief package from 2021 will expire. The Enhanced Premium Tax Credit, funded by those subsidies, resulted in an all-time low uninsured rate among Americans, with a record 24.3 million citizens signing up for 2025 policies. Four of five ACA customers were able to find plans for $10 or less a month. While a boon for low- and middle-income Americans, expanding the program would cause an estimated $212 billion deficit in government spending over 10 years, according to a 2020 Congressional Budget Office estimate. 

However, with grocery prices up 29% since the pandemic, according to the Bureau of Labor Statistics, cuts to the Supplemental Nutrition Program this summer, the energy index up 4.2% over the last year and housing costs rising faster than incomes across most of the United States since 2000, an increase in health insurance costs is simply unfeasible for many Americans.

Reasch expected that many people would switch their coverage to only catastrophic medical emergencies, leaving the everyday medical expenses to be paid out-of-pocket.

“People are possibly going to do without some of the medications that they need. …They’re going to say, ‘Hey, I can’t afford to have this, so I’m going to do without.’ So, I think health-wise it’s going to affect certain people because they don’t feel like they can afford to pay for their medications and their healthcare in general,” he said. 

ACA plan enrollment opened in November and closes January 15. Reuters reported on December 23 that enrollment under the Affordable Care Act was at 15.6 million compared to 16 million last year. A KFF poll estimated 25% of ACA enrollees would drop their plan in 2026 if their premiums increased as expected, and other estimates suggest 2 million to 4 million people will drop their health insurance. Typically, enrollment peaks in January.

“So many people are going to be affected by this, I honestly just don’t understand why they wouldn’t extend (the subsidies), maybe not in the same way that they have been, or maybe they might tweak the requirements a little bit, I don’t know,” Robertson said. “But surely, something has to be done.”