Challenges for Families Facing Affordable Care Act Changes in 2025
Robert and Emily Sory operate a sanctuary for animals with special needs near Nashville, Tennessee. This year, they face significant challenges affording their own healthcare. Last year, Robert's health insurance through the Affordable Care Act (ACA) marketplace was subsidized due to pandemic-related federal aids, resulting in zero monthly costs. However, those federal subsidies expired in 2025, with the most affordable plan now costing approximately $70 monthly.
Following Robert's job loss in November, the couple found even this reduced cost prohibitive, opting to forego insurance coverage entirely. Robert explained to KFF that without any income, even seemingly low premiums become unaffordable.
Millions, including the Sorys, are experiencing increased insurance premiums due to the cessation of enhanced ACA subsidies. At the end of 2025, Congress allowed these subsidies, which boosted financial support and eliminated income caps for eligibility, to lapse. This resulted in consumers bearing a higher portion of their premiums, even without an overall increase in coverage costs.
Federal estimates suggest a potential rise in average monthly marketplace premiums from $888 to over $1,900. Younger, healthier individuals may exit the marketplace due to these increases, impacting the risk pool and potentially driving up overall insurance costs due to altered risk assessments by carriers.
There is growing concern about a potential "death spiral," where rising premiums cause healthier individuals to withdraw, thus increasing rates for those remaining. However, analysts advise that it is premature to predict substantial declines in enrollment, as much depends on how insurers and states respond.
Self-employed individuals, freelancers, and those who have lost employer-based insurance are among the hardest hit by these premium spikes. As examples, the Sorys, both jobless, face significant out-of-pocket costs for prescriptions, now negotiating reduced fees for necessary medical visits.
Despite ending enhancements, ACA subsidies still limit premiums for lower and middle-income enrollees to around 10% of annual income. Special enrollment periods remain available for certain qualifying life events, allowing some to manage premium expenses strategically through contributions to retirement or Health Savings Accounts (HSAs), as subsidy eligibility relies on Modified Adjusted Gross Income.
Insurers' reactions to changing enrollments will heavily influence premium futures. The participation decline of healthier enrollees could further escalate costs unless mitigated by state policies or renewed federal intervention. With the conclusion of enhanced subsidies, many must reassess their insurance options, financial planning, and evaluate the affordability of their coverage choices.