Updated December 12, 2025
Originally published December 12, 2025
We've been here before: Democrats and Republicans in Congress sparring over the future of the Affordable Care Act.
But this time there is an added complication. Although we are now halfway through open enrollment, lawmakers are still debating whether to extend subsidies that have provided consumers with additional help paying health insurance premiums in recent years.
The circumstances have led to deep consumer concerns about higher costs and fears of political fallout among some Republican lawmakers.
According to KFF survey In a report released in December, about half of current members registered to vote said that if their total health care costs — copays, deductibles and premiums — increased by $1,000 next year, it would have a “major impact” on whether they vote in next year's midterm elections or which party candidate they support.
For those caught in the middle, including consumers and leaders 20 states plus the District of Columbiawho operate their own ACA marketplaces—the lack of action on Capitol Hill has led to uncertainty about what to do.
“Before I sign up, I'll wait and see what happens,” said survey participant Daniela Perez, a 34-year-old education consultant from Chicago who says her current plan will increase to $1,200 a month from about $180 this year without the tax credit extension. “I don't have much hope. It looks like things have reached a dead end.”
In Washington, as part of an agreement to end the recent government shutdown, the Senate voted Dec. 11 on a proposal to extend the subsidies. Another option proposed by Republicans, which included funding for health savings accounts, was also considered. None received the 60 votes needed to pass.
Overall, Democrats want to extend more generous subsidies created in response to the coronavirus pandemic. They expire at the end of the year. Republicans are split, with many balking at an outright extension and the political and political fallout that would come from voting to support Obamacare, long considered public enemy No. 1 by many.
And some have supported various proposals to extend tax subsidies, fearing that failure to do so would lead to political fallout in next year's midterm elections.
As a result, different political positions emerge. proposed by legislators on both sides passage and in both houses of Congress.
The White House, although supportive of HSAs in principle, didn't clarify your choice among the various Capitol Hill plans.
Meanwhile, the clock is ticking for buyers. People need to choose an ACA plan by December 15th for coverage to begin on January 1st. Open enrollment continues in most states until January 15th.
Markets should also have contingency plans in case Congress intervenes. These adjustments may take days or weeks.
“We have a plan” to update the website, including notifying consumers of any changes, said Audrey Morse Gasteyer, executive director of the Massachusetts Health Connector, the state's ACA insurance marketplace.
Still, there aren't many workdays left on the 2025 Congressional calendar, and “in many ways it feels like they're further apart than they were even a few months ago,” said Jessica Altman, executive director of Covered California, that state's ACA marketplace.
We are waiting for the numbers
Both Altman and Gasteier said it's too early to tell what final enrollment figures will be, but there are already signs of how enrollment will compare to last year's record high of about 24 million.
Centers for Medicare and Medicaid Services December 5 released Data from roughly the first month of open enrollment shows 949,450 new enrollments — people who did not have ACA insurance this year — in federal and state markets. This is slightly less than approximately the same period last year, when was 987 869 new members by early December.
However, there has been a slight increase in the number of repeat customers who have already chosen a plan for next year. That figure is about 4.8 million, up from about 4.4 million last year, according to CMS.
This initial finding—fewer new enrollees but faster action by those already insured—may reflect that “the people who come back early in the enrollment period are the ones who need coverage because they have a chronic condition or need something done,” said Sabrina Corlette, co-director of the Center for Health Insurance Reform at Georgetown University. “So they are more motivated in the front half.”
And it takes time to get the final number of participants in the federal market. “Rubber is moving with the times when people have to pay first premium,” Corlett said. “Thanks to the federal market, we won't know for some time.”
Some states also released information for the first few weeks, with the caveat that many people may wait until mid-December or later to make coverage decisions. Availability has become a pressure point.
In Pennsylvania, for exampleIn the first six weeks of open enrollment, the number of people signing up for the first time was down 16% from last year, according to data released by Pennie, the state's ACA insurance marketplace. According to Penny, for every new connection, 1.5 existing customers accounted for it.
There were some indications that income was a deciding factor: most of those who canceled their bookings earned between 150% and 200% federal poverty levelor $23,475 to $31,300 for a single adult.
In most states, existing customers are automatically re-enrolled in the same or similar coverage for the following year. Letters and other notices are sent to consumers, who can then continue coverage or go online during the open enrollment period to change or cancel their plan.
California reported New registrations dropped by 33% until December 6. And Altman said she sees other changes.
She said more people are choosing bronze-tier plans, which have lower premiums than silver or gold plans but also higher deductibles — the amount people must pay before more coverage kicks in.
At the national level average deductible for bronze plan Next year it will be $7,476, while silver plans have an average deductible of $5,304, according to KFF, a nonprofit health information organization that includes KFF Health News.
“It's a warning sign that people are being forced into plans with really high deductibles,” Altman said.
In Massachusetts, consumer calls to the state market were up 7% in the first month compared with last year, Gasteyer said.
Additionally, “our call centers are getting heartbreaking phone calls from people saying they can't figure out how they can stay covered,” she said.
Difference detail
If the expanded tax breaks expire, Obamacare subsidies will return to pre-pandemic levels.
Households will pay a percentage of their income toward the premium, and the tax credit subsidy will cover the remainder, with the payment usually made directly to the insurer.
Expanded subsidies reduced the amount of household income people had to pay for their own insurance, with people with the lowest incomes paying nothing. Additionally, there was no upper limit on income that could qualify for the program, which drew particular criticism from Republicans. However, the reality is that some high-income people don't receive the subsidy because their premiums without it are less than they should pay.
Next year, without more generous subsidies, people on the lowest incomes will pay at least 2.1% of their family income towards insurance premiums, with the highest earners paying almost 10%. No subsidies will be available to people whose income is more than four times the federal poverty level, which is $62,600 for an individual or $84,600 for a couple.
For those currently purchasing coverage, this cap means a dramatic increase in coverage costs. Not only have insurers increased premiums, but subsidies for this group have now been cut entirely.
“They said based on our salary, we didn't qualify,” said Debra Nweke, who is retired at 64 and whose 62-year-old husband is still working. They live in Southern California and plan to increase their coverage from $1,000 a month this year to $2,400 a month next year if they stay on the same ACA plan. “How can you have health insurance that costs more than your rent?”
Senate Majority Leader John Thune said in early December that Republicans want a solution that will lower health care costs, but not a solution in which “people who make unlimited amounts of money can qualify for government subsidies.” He also objected to providing free insurance to those at the bottom of the income scale.
Even those who receive subsidies say they feel disadvantaged.
“Our prices are going up, but even so, I have no other choice,” said Andrew Schwartz, a 38-year-old preacher from Bowie, Texas, who gets ACA coverage for himself and his wife. His three children are on the government health insurance program because the family is classified as low-income. Both Schwartz and Nweke took part in the KFF survey.
Schwartz's coverage will increase from $40 a month this year to $150 a month next year, in part because he chose a plan with a lower deductible than some other options.
Schwartz said that while there are many problems with the health care system as a whole, Obamacare has helped his family. They will simply have to take the extra expenses from elsewhere in the family budget, he said.
