In Illinois, about 550,000 people are enrolled in exchange plans, and 91% of them get the enhanced premium tax credits.<\/p>\n
\u201cEverybody is going to be hit by this,\u201d said Ann Gillespie, director of the state Insurance Department, during an October news conference.<\/p>\n
Insurance industry group AHIP blamed drugmakers and hospitals for the higher prices, and said in a statement that health insurers are \u201cdoing everything in their power to shield Americans from the full impact of rising costs.\u201d The group has been urging Congress to extend the enhanced subsidies.<\/p>\n
Subsidies have long been part of Affordable Care Act exchange plans, helping to offset the monthly costs of coverage. In 2021, amid the COVID-19 pandemic, a bill was signed into law to make the subsidies more generous and to expand them to more people. The Inflation Reduction Act then extended the more generous subsidies through 2025.<\/p>\n
During most of the recent government shutdown, Democrats refused to pass a funding bill to reopen the government unless Republicans agreed to extend the enhanced subsidies past this year. Last week, however, a group of Democrats agreed to vote to reopen the government without extending the enhanced subsidies.<\/p>\n
A Senate vote on extending the subsidies is expected in December, but it\u2019s unclear how that vote will go, with many Republicans still adamantly against extending the subsidies. Republican House Speaker Mike Johnson has called the enhanced credits \u201ca boondoggle\u201d that is subsidizing \u201cbad policy,\u201d and President Donald Trump has proposed no longer funding the subsidies and instead sending that money directly to Americans.<\/p>\n
If the enhanced credits aren\u2019t extended, many of the hardest-hit people will likely be those at the lower and higher ends of the income spectrum, Hempstead said. Many people will still get subsidies, but they won\u2019t be as generous.<\/p>\n
Individuals with lower incomes, for example, may go from paying nothing each month to more than $60 a month for a mid-level plan, according to an online calculator from KFF<\/a>, a nonprofit organization focused on health policy.<\/p>\n \u201cTo a low-income person, that is a lot,\u201d Hempstead said. \u201cWe anticipate a lot of those people will drop coverage because they feel like they can\u2019t shoulder that expenditure.\u201d<\/p>\n People at the higher end of the income spectrum will face some of the most dramatic increases. People who make more than 400% of the federal poverty level would no longer be eligible for any subsidy, if the enhanced tax credits aren\u2019t extended.<\/p>\n Four-hundred percent of the federal poverty level may sound like a big number, but it\u2019s far from wealthy. For a single person, 400% of the federal poverty level is an annual income of $62,600, and for a two-person household, it\u2019s $84,600 this year.<\/p>\n That\u2019s part of the reason the Fortinis are bracing themselves for a giant increase in the cost of their exchange plan health coverage next year. They\u2019re above the 400% poverty level, so they would no longer get any subsidy at all, if the enhanced subsidies aren\u2019t extended.<\/p>\n The couple knows that they\u2019re relatively lucky. They decided to retire early a few years ago, in large part to help care for their elderly parents. They planned carefully for their retirement, and they understood that the costs of their health insurance coverage would likely rise each year.<\/p>\n But they didn\u2019t account for this much of a jump. If they have to pay $2,200 a month for exchange coverage, their money won\u2019t last as long as they need it to, Ross Fortini said.<\/p>\n \u201cFive years of these increased premiums is enough to make our entire retirement plan fall apart,\u201d said Ross Fortini, referring to the five years he has left until he qualifies for Medicare.<\/p>\n In addition to thinking about where to cut their spending, they\u2019re also exploring other options for health care. One idea they\u2019re considering is getting very low level health insurance coverage and then paying for a concierge doctor. With concierge doctors, people typically pay a monthly or annual fee for access to a doctor.<\/p>\n \u201cIf this is impacting us, who have planned as carefully as we have and have options, it scares me and worries me so much for people who don\u2019t,\u201d Paula Fortini said.<\/p>\n Natalie Roth, of Avondale, feels like she has few options for health coverage next year if the enhanced subsidies aren\u2019t extended. She\u2019s had an exchange plan for a couple of years \u2014 but the price of that plan is set to increase by about $150 a month.<\/p>\n She already has the lowest level plan offered on the exchange \u2014 a bronze level plan. She thinks she could potentially avoid additional costs by signing up for an HMO plan rather than a PPO, but she said she\u2019d no longer be able to see her primary care doctor. She\u2019d have to find a new doctor, and she worries about accessing other services as well.<\/p>\n But if she doesn\u2019t move to an HMO, she\u2019ll have to figure out how to cut expenses from her already lean budget.<\/p>\n \u201cI don\u2019t plan on being without insurance because if something happens that would just blow up my finances,\u201d said Roth, 35, who is self-employed. \u201cI want to still be responsible, and I want to take care of myself, but financially that is going to be a strain.\u201d<\/p>\n \u2018Grave decisions\u2019<\/p>\n Health insurance broker Ryan Kennelly said many of his clients are feeling sticker shock.<\/p>\n People who may be paying only a few dollars to $60 a month for coverage now are looking at costs of $100 or $200 a month \u2014 increases that aren\u2019t in their budgets, he said.<\/p>\n He said many of his clients haven\u2019t decided what to do.<\/p>\n \u201cPeople who are going to the doctor a few times a year and not needing any other major services are trying to wait to see if their friends or family or someone comes up with a better option,\u201d said Kennelly, principal and senior benefits consultant at Independent Health Agents, a Chicago-based brokerage. \u201cAs brokers we have some (options), but there\u2019s not going to be a silver bullet.\u201d<\/p>\n Chicago broker Jordan Wishner said he anticipates many people with exchange plans will drop their coverage. Many of Wishner\u2019s clients will no longer be eligible for subsidies at all if the enhanced credits aren\u2019t extended. While the Affordable Care Act has helped many people get insurance who otherwise might not have been able to pay for it, he said it\u2019s been tough for middle- and higher-income people who want quality, affordable coverage.<\/p>\n \u201cThey have to make some grave decisions, and really the only ones I personally see that are going to pull the trigger and pay that premium are the ones that need care,\u201d said Wishner, who is president of the Health Insurance Shoppe.<\/p>\n![\"Paula](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/CTC-HEALTH-INSURANCE-COSTS-1109005_246690824.jpg\")
Paula and Ross Fortini, of Libertyville, Nov. 6, 2025, have insurance through the Affordable Care Act exchange. (Stacey Wescott\/Chicago Tribune)<\/p>\n