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Alyssa Black is among them. As the chair of the Vermont House of Representatives Health Care Committee and a health care administrator by trade, Black is deeply familiar with the importance of affordable insurance. Even so, she contemplated cancelling her Obamacare plan after learning her new premium would be $1,144 a month, compared to $414 last year.

“I cannot afford that,” Black, a Democrat who represents the town of Essex , said she thought when she saw her new bill. “That is more than my mortgage and taxes… And it is frightening to me.”

Black said she managed to negotiate a raise at work to help ease the financial burden. Others haven’t been as fortunate.

Data from the Massachusetts state health care marketplace show more than 10,000 residents dropped their insurance plans last month during the open enrollment period, nearly double the amount who did the same last year.

“People who are dropping their insurance don’t just go away,” said Representative Stephen Lynch, a South Boston Democrat. “As people lose their health insurance, they’re going to the emergency room more.”

Lynch predicted the influx of uninsured emergency room visits will worsen wait times for hospital beds; a particularly fraught issue in his district, which contains several hospitals in financial trouble following the collapse of Steward Health Care. Like other members of Congress reached for this article, Lynch said he has fielded concerns from local hospitals that treating a larger volume of uninsured patients will lead to higher health care costs for the entire community.

Whether the ACA subsidies should be extended was the central sticking point amid budget negotiations with Republicans last year. Gridlock on that issue culminated in a record-long government shutdown, which ceased only when several Democratic senators struck a deal in November to re-open the government without a GOP guarantee that the subsidies would be extended.

Since then, negotiations for a new solution have been ongoing. This month, 17 House Republicans voted with Democrats to extend the enhanced ACA subsidies for three more years in defiance of House GOP leadership, but the legislation has stalled in the Senate.

So far, Trump has been reticent to back the extension, which the nonpartisan Congressional Budget Office said would cost about $80 billion over the next decade. The subsidies would also increase the number of Americans with health insurance by 100,000 this year, 3 million next year, 4 million in 2028 and 1.1 million in 2029, according to CBO.

Trump recently unveiled his own proposal to lower the cost of health care, which largely centers on funneling the subsidy money into health savings accounts for eligible Americans and reducing prescription drug prices.

Party politics aside, the lapse of the ACA subsidies has added a new dimension to the personnel decisions of Lucinda Chrislip, owner of Derby Farm Flowers & Gardens in Arlington and Newton.

Chrislip said she cannot yet afford to offer health insurance benefits to her employees, so many of them rely on the ACA marketplace. One of her most experienced florists, she said, told her in the fall that if the subsidies were not extended, she may have to find a new job that pays more in order to afford coverage. Chrislip said she gave the florist more hours to accommodate the increased cost of health insurance at the expense of hiring additional help for the busy Valentine’s Day season.

“I want to take care of my employees who have been loyal and hard-working, but I can’t also just come up with extra money to increase wages when inflation, cost of goods, like everything is so hard right now,” Chrislip said, adding that she would like to see lawmakers from both parties “work together to negotiate, to compromise.”

Her congressman, Democrat Jake Auchincloss of Newton — who has placed health care at the forefront of his political career — said the debate over subsidies is the start of a larger fight. “The ACA subsidies are a short-term necessity,” he said, “they are not a long term strategy.”

Massachusetts Governor Maura Healey announced this month that the state will use $250 million to help insulate residents from costly premiums. Even so, Representative Katherine Clark of Revere knows the outlay is not a sustainable fix.

“We need the federal government to step up,” said Clark, the second-ranking House Democrat. “The state has limits and we need to continue to be a partner with them, or we will see dramatic impacts on what is happening to healthcare, to our hospital systems, to our ability to meet the needs of everyone in the Commonwealth.”

Sarah Cordero, a small business owner from Cranston, RI, now pays $1,036 a month to insure her family of four, a $488 a month increase from last fall.

Cordero said the new expense will stop her from reaching financial goals like paying off debt from starting her home inspection business, starting a college fund for her kids, or buying a new, more spacious home.

“You sort of feel like — was it Sisyphus who was climbing the hill? And the stone just keeps rolling down the hill and he just has to keep on getting it and going back up again,” Cordero said. “It just feels like there’s never an end. Like you work, and you work, and you work to try to achieve goals and feel like you are hitting milestones and getting ahead and that goal just keeps on moving farther and farther.”

Farther north, a 59-year-old semi-retired small business owner from Pembroke, N.H., said the loss of the enhanced ACA tax credits has meant the monthly premiums for a policy covering herself and two college-aged sons has jumped to nearly $1,000, up from $350 last year. She’s managing to pay it, but not without cutting back on other expenses.

“It puts this low-grade anxiety about everything into my life,” said the woman, who did not want her name used out of fear of backlash. “For me, it’s only low-grade. For people who are living paycheck to paycheck, that’s excruciating.”

Representative Maggie Goodlander, a Democrat from New Hampshire, which has the nation’s second-oldest population, said many of her constituents face the same dilemma.

“This is a life-or-death issue for a lot of people who just are having to make these horrible choices about the kind of care that they’re going to be able to get,” said Goodlander, who was part of the bipartisan group of lawmakers who worked to pass the extension legislation through the House.

The increased health care premiums pile on top of other rising costs, particularly for utilities and housing, Goodlander said.

Massachusetts Senator Ed Markey likened the expiration of the tax credits to “a ticking healthcare time bomb” that finally exploded when Americans’ 2026 premium bills arrived.

“People may have been distracted by Thanksgiving or by Christmas, but now… they are feeling it,” he said. “People are angry and scared at the same time.”

An earlier version of this story misstated the town Alyssa Black represents. She represents Essex, which is in Chittenden County.

Julian E.J. Sorapuru can be reached at julian.sorapuru@globe.com. Follow him on X @JulianSorapuru. Jim Puzzanghera can be reached at jim.puzzanghera@globe.com. Follow him @JimPuzzanghera. Shae Lake can be reached at shae.lake@globe.com.