By Dan DeWitt
Virginia Gilbert was shocked and angry after she learned last week that premiums for her Affordable Care Act (ACA) insurance policy will more than double next year, jumping from $930 to $2,042.
She was freshly outraged after U.S. senators reached an agreement this week to end the six-week government shutdown without securing an extension of enhanced premium tax credits for ACA-backed plans.
That leaves little prospect for the continuation of bigger subsidies and little hope of adequate assistance for people like Gilbert – a self-employed marriage and family therapist – who don’t have access to employee-backed coverage, she said.
Gilbert and other ACA enrollees interviewed by Asheville Watchdog are considering a range of options to address these costs – from working more, to choosing bare-bones plans or even dropping healthcare coverage altogether.
“I’m not really even thinking about myself at this point,” said Gilbert, 63, whose expected 2026 premiums will roughly equal the monthly mortgage payments for her Asheville condominium.
“What happens to the country if most people who don’t have employer-funded health insurance can’t afford health insurance?” she asked rhetorically. “It just feels so dystopian.”
Gilbert is one of 975,000 residents in North Carolina and nearly 32,000 in Buncombe County covered by ACA-backed plans, said Nicholas Riggs, of Legal Aid of North Carolina and the director of the NC (ACA) Navigator Consortium.
The expected jump in her premiums is typical, according to health research nonprofit KFF, which has estimated a 114-percent average increase in the cost of ACA-backed plans. KFF and other sources also show that higher healthcare costs in western North Carolina are resulting in higher premiums than in much of the rest of the state.
ACA policyholders face difficult choices with much reduced federally funded support, said Riggs, whose consortium advises current and potential ACA plan enrollees.
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The Trump Administration previously cut the federal Centers for Medicare & Medicaid Services (CMS) funding for the network of ACA navigators by 90 percent nationally and from $7.5 million to $750,000 in North Carolina, Riggs said. Several nonprofits are continuing this work with other funding sources and Legal Aid of North Carolina, which has received a grant from Dogwood Health Trust and operates an office in Sylva. But the cut has left Pisgah Legal Services as the only CMS-funded navigator in much of the 18 counties in western North Carolina.
“We don’t have as much capacity as we did last year at a time when a lot of people need more help than ever,” said Riggs, who added that because of the predicted strains on the navigation network people needing guidance should reach out long before the Jan. 15 end of the ACA open-enrollment period.
The KFF online premium calculator shows costs of ACA-backed plans in Asheville are about 15 percent higher than, for example, in Raleigh.
“Some areas like western North Carolina are dominated by only one hospital system,” the North Carolina Blue Cross Blue Shield website says, referring to HCA Healthcare-owned Mission Health. “That lack of competition not only drives up the cost of care but also makes it much more difficult for insurers to negotiate lower prices with hospitals.”
The elimination of enhanced subsidies would come on top of cuts to ACA in July’s One Big Beautiful Bill Act budget reconciliation, which included the future elimination of enhanced tax credits for several groups of legal immigrants, including Deferred Action for Childhood Arrivals (DACA) recipients.
The continuation of enhanced premium tax credits was the centerpiece of the budget fight that led to the federal government shutdown. Originally approved as part of the 2021 American Rescue Plan Act (ARPA), the program of boosted subsidies expanded eligibility to enrollees earning more than 400 percent of the federal poverty level, and lowered caps on premiums based on income.
“For example, with the enhanced tax credits in place, an individual making $28,000 will pay no more than around 1% ($325) of their annual income towards a benchmark plan,” a KFF web page says. “If the enhanced tax credits expire, this same individual would pay nearly 6% of their income ($1,562 annually) towards a benchmark plan in 2026.”
The expanded subsidies were due to expire at the end of this year, and Democratic senators had previously said they would not agree to reopen the government until Republicans agreed to extend them. But on Sunday, eight members of the Democratic caucus said they would vote to reopen the government until the end of January without a commitment to extend the subsidies. They did so Monday night.
Republican Senate leaders have agreed only to a vote on the issue in December, believed to have little chance of passing, and President Trump has announced his opposition to the extension in a social media post, calling the subsidies “a windfall for Health Insurance Companies and a DISASTER for the American People.”
A direct jump in premiums, plus secondary increases
But the end to enhanced credits are leading not only to a direct jump in premiums, but to secondary increases based on actuarial calculations, according to KFF. As subsidies drop and rates climb, insurers expect “healthier enrollees to drop coverage” its website says. “That, in turn, increases underlying premiums.”
Riggs said he was not in a position to comment on the prospects for passing an extension, but he did share Gilbert’s concern about the impact of reduced subsidies on small businesses. The population covered by ACA-backed plans is disproportionately self-employed, he said.
“When premiums are affordable, it allows people the freedom to become entrepreneurs. It allows people the ability to open up their own businesses, or be job creators,” he said. “When it’s not affordable, that’s when you see a ripple effect throughout the economy.”
Gilbert said she is healthy except for a digestive issue that requires expensive medication. Paying for that out of pocket would cost far less than her 2026 ACA-backed Blue Cross Blue Shield plan, she said.
She could cut out vacations and work more hours to fill the cost gap, she said. She has also considered doing without coverage until she qualifies for Medicare in less than two years.
But in light of cuts to so many federal programs, even Medicare doesn’t seem like a sure thing, she said. “All the scaffolding structures that supported people, especially as they get older, they’re just kind of disappearing.”
Sarah Laliberte, 43, a freelance textbook editor, said the subsidy structure creates a “very odd” incentive to earn less money.
An increase from $1450 per month to $3,145
She is currently paying $1,450 per month to cover herself, her husband and their two children, ages eight and 10. Her expected monthly premium will climb to $3,145 based on an estimated household income of $150,000.
But her husband was recently laid off after the food program he worked for lost its state grant. Her work has dried up in the past year due to increased federal oversight of politically controversial teaching material.
Because the subsidies are prepaid reimbursements on income tax, their monthly premiums would fall to about $1,000 if she reduced their estimated income to $75,000.
But that would mean taking a big year-end hit if her husband finds another job and she secures more work.
“Where would that put us at the end of the year for our income?” she asked rhetorically. “Is this going to put us over the limit to all of a sudden have to pay back $24,000?”
Carlos Halasz, 62, is retired from a job in international trade compliance with Hewlett-Packard and his wife receives Medicare coverage, he said.
Though he was dismayed to read the letter from his insurer saying his premiums will more than double, he considers himself lucky because the costs won’t be crippling, and he’s more worried about what the increases will mean for less fortunate ACA policyholders.
That includes Mary Williams, 62, who said she cannot hope to pay her premiums, which are set to soar from $172 to $1,879.
Her subsidy was based on her modest income as a freelance artist and musician, she said. Her rent recently tripled because two roommates moved out and she is paying off her $900 share of an emergency room bill for a kidney stone treatment.
“I can’t pay that,” she said of the hospital bill, and her insurance premiums would come to more than half her salary.
“It’s like a 1,000 percent increase,” she said. “I mean, there’s no way.”
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Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Dan DeWitt is The Watchdog’s deputy managing editor/senior reporter. Email: ddewitt@avlwatchdog.org. Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
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cry me a River a household making $150,000 a year isn’t getting cheap insurance. And if you make less than $25,000 you don’t even have to pay for anything you get better insurance than everybody else so it pays to be broke don’t even try to get a higher paying job or make sure you don’t work too much or you might lose your insurance for free
There’s a perverse incentive for insurance companies to raise premiums when they know they’ll be covered by taxpayer subsidies. We can see the same thing happening with college tuition and the huge increases in administrative personnel. Easy availability of loans.
People seem to want pity from taxpayers because they choose a lifestyle of being self employed and to fund their own health care while the person in this article buys a condo at $2000 a month and complains of insurance costs. Really? She needs to get off of the taxpayers back please. Look at the simple math here, 12 times a year she pays $2000 a month for a total of $24,000 a year for a condo but feels she should not have to pay $2000 once a year for insurance. That is only about 8% of her annual condo note, again, really? She cannot pay about $166 a month for health insurance? Retired people living on a fixed income have zero desire to fund her insurance. Our premiums tripled with ACA when we were still working to fund others insurance, where is the pity for the working people that were scammed by ACA to the tune of 10’s of thousands of dollars each and now finally have hopes this boondoggle will end. ACA raped us and many, many more Americans of $72,000 over our previous rates before we retired. This fleecing of Americans for employed peoples insurance costs needs to stop.