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"I might die if I stop going to the doctor," said one Tennessee resident whose premiums jumped from $10 to $1,140 a month.
More than 20 million Americans are expected to see their health insurance premiums more than double next year after Republicans refused to extend a tax credit for those who purchase health insurance on the Affordable Care Act marketplace.
And as the GOP remains firm in its stance that it will not vote to extend the credits in order to end the government shutdown entering its third week and the open enrollment period for ACA insurance fast approaching, Americans in some states are already getting a glimpse into how the price of their insurance will skyrocket in 2026.
On Wednesday, ACA health insurance marketplaces in six states—California, Maine, Minnesota, Vermont, Oregon, and Kentucky—launched "window shopping" tools that allow residents to compare their current insurance premiums with the ones they can expect to pay next year.
Across each of these states, the advocacy group Protect Our Care found plans that are expected to increase dramatically, sometimes to prices several times higher than they were this year.
“There is no longer any doubt about the healthcare disaster Republicans have created,” said the group's chair, Leslie Dach. “Working families can now log onto a computer and see the Republican healthcare betrayal right before their eyes."
Middle-income Americans who are older, but not yet old enough to receive Medicare, are expected to see the steepest increases in their premiums, according to KFF. When Protect Our Care looked at plans for 60-year-old couples making $85,000 a year, the group found staggering results in each state.
In Clay County, Kentucky, the group found that a Clear Silver plan, which charges that couple a premium of $559 per month this year, will cost $2,736—nearly five times that amount—next year after subsidies expire.
A screenshot of California's Affordable Care Act insurance marketplace website shows the price of an Anthem Blue Cross Silver plan for a couple in Mission Viejo, California, in 2025 (L) vs. 2026 (R). (Screenshot from Protect Our Care)
In Mission Viejo, California, premiums for the same couple's Anthem Blue Cross Silver plan would more than quadruple, from $516 per month this year to $2,188 next year.
The same is true in Medford, Oregon, where a Moda Health Silver plan would increase from $622 this year to $2,644.
In Burlington, Vermont, an MVP Silver plan that costs $602 per month this year will spike to $2,577.
While these are particularly egregious examples, KFF estimated earlier this month that the average ACA recipient will see their premiums increase by 114% next year, which the nonpartisan Congressional Budget Office expects will result in more than 4 million people becoming unable to afford health insurance.
State-level estimates from the Center on Budget and Policy Priorities (CBPP) found that across the states that have opened window shopping, costs for many families were doubling, tripling, or worse.
Residents across the country are beginning to grapple with the extraordinary rise in costs they are about to face.
In Tennessee, where more than half a million people pay lower premiums due to the ACA subsidies, a 62-year-old Chattanooga resident, Cheri Roberts, told the Chattanooga Times Free Press that if they are allowed to expire, her current $10 a month premium will explode to $1,140 next year.
"I just had no idea," Roberts said about the expiring tax credits, adding that she sees eight different specialists for varying health issues and has multiple surgeries planned. "I'm not trying to exaggerate, but I might die if I stop going to the doctor."
Julia Tilley, a resident of Harrisburg, Pennsylvania, told PennLive/The Patriot-News that she fears her premiums will soar as Pennsylvania's insurance department predicts a premium increase of 102% on average for its 530,000 ACA recipients.
Though she says she has not yet received a letter from her insurer, Tilley said one of her friends was told their family's premiums were ballooning from $100 to $1,800 a month.
“There’s really no way to prepare for it,” Tilley said. “I mean, how do you suddenly come up with $15,000 more a year? My husband can’t work more because he has a head injury."
Tilley says she already works full-time taking care of her adult daughter, who has autism. "It’s not like I can go get another job," she says. "So we’re stuck.”
She says she has tried on multiple occasions to reach out to her Republican congressman, Rep. Scott Perry, but has not heard back.
According to KFF, 57% of ACA recipients live in congressional districts represented by Republicans, and polls by the organization have suggested that failure to extend the subsidies may hurt their electoral chances.
A poll from early October found that 78% of adults say that Congress should extend the subsidies, including the vast majority of Democrats and independents and even 57% of self-identified "MAGA" Republicans. If the subsidies are not extended, 39% who support extending them have said they'd blame US President Donald Trump, while another 37% say they'd blame Republicans in Congress. Just 22% say they'd blame Democrats.
"Virtually all marketplace enrollees—across states, ages, family sizes, and income levels—will see big premium increases," said Gideon Lukens, a senior fellow and director of health policy research for CBPP. "These are real people facing real consequences if Congress doesn’t act to extend the enhancements as soon as possible."
"Hospitals count on Medicaid to keep their doors open," said healthcare advocacy group Protect Our Care. "Medicaid accounts for one fifth of spending on hospitals, one fifth of hospital discharges, and at least one in five inpatient days in nearly every state."
The healthcare advocacy organization Protect Our Care has been tracking financially troubled hospitals across the country that are projected to take a big hit thanks to the Medicaid cuts in the massive Republican budget package—and the group has produced a new tool to let people see the damage being done in real time.
The organization on Wednesday launched a new project called "Hospital Crisis Watch" that identifies and provides updates on healthcare facilities around the country at risk of closure thanks to the Medicaid cuts, and produced an interactive map showing exactly which hospitals and medical centers are in danger.
These are all the hospitals in America that are already facing cuts and closures so Trump can give more tax breaks to the rich.
via @ProtectOurCare pic.twitter.com/ws9PqqJWBA
— Americans For Tax Fairness (@4TaxFairness) August 20, 2025
Protect Our Care found that the most vulnerable facilities tend to be in rural areas, identifying 338 endangered rural hospitals throughout the US. The state of Kentucky has the largest concentration of vulnerable hospitals with 35, followed by Louisiana at 33, and California at 28.
In a report about the threats these hospitals face, Protect Our Care explained why Medicaid funding, which the GOP budget package slashed by $1 trillion over the next decade, is vitally important to these institutions' financial well being.
"Hospitals count on Medicaid to keep their doors open," the report said. "Medicaid accounts for one fifth of spending on hospitals, one fifth of hospital discharges, and at least one in five inpatient days in nearly every state."
The report also pointed to an analysis from Commonwealth Fund estimating that more than 475,000 healthcare workers would lose their jobs as a result of the cuts. This would have serious economic ramifications for rural areas given that "hospitals employ 10% of all employees in rural counties that report having any hospital employment," explained Protect Our Care.
Even if these hospitals don't shut down, Protect Our Care warned that they are likely to slash services and increase wait times in emergency rooms.
The potential closure of hospitals isn't the only crisis facing American healthcare. A separate report from Protect Our Care earlier this week documented how health insurance premiums are expected to skyrocket in the coming year unless the Republican-led Congress passes an extension to enhanced subsidies for people who buy their insurance through the exchanges created by the 2010 Affordable Care Act.
Our one big beautiful premium is about to get much bigger https://t.co/reN0uyyiPw
— Ryan Grim (@ryangrim) August 21, 2025
"Because of these GOP policies, insurance companies have already indicated they plan to raise premiums for 24 million Americans by an average of 15%," the group noted. "At the same time, Republicans are ripping away tax credits from 20 million, forcing them to pay an average of 75% more for their coverage. These price hikes will cause countless hard-working families to lose life-saving coverage while millions more will suffer under the already-rising cost of living."
"He knows his plan to cut nearly $1 trillion from Medicaid is so deeply unpopular that he would rather sweep it under the rug and not mention it at all."
President Donald Trump's address to a joint session of Congress Tuesday night was the longest in recent history, giving him ample opportunity to lay out his complete legislative agenda to the American public.
While Trump highlighted his push for "permanent income tax cuts"—which would disproportionately flow to the rich—he did not once mention that he has endorsed a House GOP plan to offset some of the costs of those tax cuts by taking a sledgehammer to Medicaid, which provides health coverage to more than 70 million low-income people in the United States.
In fact, the only mention of Medicaid during the address came not from Trump but from Rep. Al Green (D-Texas), who yelled at the beginning of the speech that the president "has no mandate to cut Medicaid."
House Speaker Mike Johnson (R-La.) subsequently ordered the sergeant-at-arms to remove Green from the House chamber.
"Trump can try to run from his war on American healthcare, but he can't hide from it."
Medicaid cuts are extremely unpopular with U.S. voters, including Trump supporters, according to recent survey data. And Republicans know it: Rep. Jeff Van Drew (R-N.J.), who voted for the budget resolution calling for huge cuts to Medicaid, warned Trump in a phone call last week that the GOP "could very easily lose the majority for it."
Brad Woodhouse, president of the advocacy group Protect Our Care, said that could help explain why Trump omitted any mention of House Republicans' proposal for $880 billion in cuts to Medicaid over the next 10 years—cuts that could strip healthcare from tens of millions of people across the country.
Protect Our Care organized a "Hands Off Medicaid" display outside the White House ahead of the president's address.
"Donald Trump can try to run from his war on American healthcare, but he can't hide from it," Woodhouse said in a statement late Tuesday. "He knows his plan to cut nearly $1 trillion from Medicaid is so deeply unpopular that he would rather sweep it under the rug and not mention it at all."
"While people are struggling to pay their bills, he wants to raise the cost of healthcare and take away coverage that millions of people count on," Woodhouse added. "Trump is breaking the promises he made to the American people just to provide his billionaire friends with tax cuts."
No plan to lower health care costs. No solutions to bring down prescription drug prices. Not a single mention of Medicaid, which covers more than 72M Americans. Trump has no answers for the health care crises facing working families—because they’re the ones making it worse.
— Protect Our Care (@protectourcare.org) March 4, 2025 at 11:02 PM
As Trump celebrated the destructive actions he's taken during the opening weeks of his second White House term and rattled off examples of purportedly wasteful spending he claimed was identified by the Elon Musk-led Department of Government Efficiency, Rep. Alexandria Ocasio-Cortez (D-N.Y.) quipped that "this list is so long and taking up so much real estate in his speech it's almost like they want to distract from their massive cuts to Medicaid."
"Trump backed the GOP into a big corner with his 'balanced budget' point," Ocasio-Cortez added, referring to the president's expressed desire to "do what has not been done in 24 years: balance the federal budget."
"The ONLY way the House GOP could even think about upholding their 'no cuts to Medicaid' swing seat promises and their spending cut mandates is deficit spending and bad math," the New York Democrat wrote. "Now they have to gut Medicaid and hand it to Elon in public."
Sharon Parrott, president of the Center on Budget and Policy Priorities, observed that the recently passed House GOP budget resolution's tax cuts "are so large that even with massive cuts to Medicaid, SNAP, and student loans that budget would INCREASE the deficit."
During his address, Trump claimed that "the next phase" of his economic plan is "for this Congress to pass tax cuts for everybody."
But an analysis published last week by the Economic Policy Institute (EPI) found that the Medicaid cuts outlined in House Republicans' budget resolution would "squander most of the meager benefits from the [Tax Cuts and Jobs Act] extension even for families in the middle fifth of the income distribution."
"Medicaid cuts will substantially reduce incomes for families in the bottom 40% (the bottom two-fifths) of the income distribution," EPI found. "For the bottom fifth, $880 billion in Medicaid cuts over the next decade would translate into Medicaid benefit reductions equal to 7.4% of their money income. For the second fifth, these cuts would equal 1.7% of their money income."
In his response to the president's speech Tuesday night, Sen. Bernie Sanders (I-Vt.) said that "in so many words, Trump urged Congress to pass his 'big, beautiful budget.'"
"Do you know what's really in it? This budget would cut Medicaid by $880 billion. Oh, I guess Trump forgot to talk about that," said Sanders. "According to one estimate, it means that up to 36 million Americans, including millions of children, would be thrown off the health insurance they have."
"A 90-minute speech tonight," the senator added, "not one word about throwing millions of kids off of the health insurance they have."