The Big Changes To ACA Premiums At The Heart Of The Government Shutdown

Forbes

Expect some surprises when Open Enrollment for health care coverage through the ACA Marketplaces begins. Premiums are going up and the enhanced premium tax credits that help Americans afford health care coverage are scheduled to expire.  Read the full story on Forbes: https://www.forbes.com/sites/kellyphillipserb/2025/10/29/the-big-changes-to--aca-premiums-at-the-heart-of-the-government-shutdown/  Subscribe to FORBES: https://www.youtube.com/user/Forbes?sub_confirmation=1  Fuel your success with Forbes. Gain unlimited access to premium journalism, including breaking news, groundbreaking in-depth reported stories, daily digests and more. Plus, members get a front-row seat at members-only events with leading thinkers and doers, access to premium video that can help you get ahead, an ad-light experience, early access to select products including NFT drops and more:  https://account.forbes.com/membership/?utm_source=youtube&utm_medium=display&utm_campaign=growth_non-sub_paid_subscribe_ytdescript  Stay Connected Forbes newsletters: https://newsletters.editorial.forbes.com Forbes on Facebook: http://fb.com/forbes Forbes Video on Twitter: http://www.twitter.com/forbes Forbes Video on Instagram: http://instagram.com/forbes More From Forbes:  http://forbes.com  Forbes covers the intersection of entrepreneurship, wealth, technology, business and lifestyle with a focus on people and success.

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00:00Today on Forbes, the big changes to ACA premiums at the heart of the government shutdown.

00:07The Affordable Care Act, or ACA, marketplace, open enrollment period begins tomorrow,

00:14Saturday, November 1st, 2025, in most states, and it's shaping up to be a tricky one.

00:21Premiums are going up, and the enhanced premium tax credits that have helped millions of Americans

00:27afford health care coverage are scheduled to expire at the end of the year.

00:31The debate over extending the credits has become a major sticking point in Washington,

00:36and one of the reasons for the current federal government shutdown.

00:40The issue is that in the Republicans' quote, one big beautiful bill act they passed in July,

00:46they made permanent many other tax breaks, and even created some new temporary ones,

00:50but did not extend the ACA tax credits.

00:54Senate Republicans aren't keen to do so in any short-term funding measure,

00:59and Democrats have said they won't support any funding bill that leaves the tax credits out.

01:04If you're unemployed or your employer doesn't provide health care insurance,

01:09or if you're self-employed or own a small business, finding individual coverage can be difficult.

01:14The solution, courtesy of the ACA, which is also known as Obamacare,

01:19was the creation of health insurance marketplaces.

01:22The marketplaces allow individuals to buy health insurance coverage that isn't tied to employment.

01:28Marketplaces offer different levels of coverage, and the coverage is private pay,

01:33meaning individuals choose and pay for their own coverage.

01:36There is a health insurance marketplace in every state.

01:40According to the latest count by KFF, a not-for-profit health care think tank,

01:4421 states, including California and New York, operate their own marketplaces.

01:50In other states, the federal government runs the marketplace, which can be found at healthcare.gov.

01:56The marketplace option makes it easier for some groups, like small business owners, to get coverage.

02:02The Center for American Progress reports that about 5.2 million small business owners

02:07and self-employed Americans are covered through the marketplaces.

02:11Marketplace health care insurance premiums turned out to be still too high for a lot of people.

02:17The solution?

02:18Premium tax credits that lowered premium costs.

02:21The amount of help you receive depended on your income, age, and the cost of plans in your area.

02:26In 2021, Congress expanded these tax credits, but only temporarily.

02:32The formula was revised so that lower-income households paid a smaller portion of their income

02:37toward their monthly premium.

02:39The changes also removed the income cap, allowing people earning more to still qualify for help

02:45if their premiums were high relative to their income.

02:48Notably, the formula capped what anyone would pay for a benchmark silver plan at about 8.5% of their income.

02:55There are four kinds of plans—bronze, silver, gold, and platinum.

03:00Silver plans, which are the most popular, cover about 70% of healthcare costs.

03:05The result is that these tax credits lower the cost of healthcare coverage,

03:10and especially so for older adults who face higher premiums.

03:14That's because premiums are age-based.

03:16Without subsidies, a person who is 52 will pay about twice as much as a person who is 21,

03:21and a person who is 64 will pay three times as much as a person who is 21.

03:27According to KFF, over half of marketplace individual enrollees with incomes over four times

03:33the federal poverty level, or FPL, are aged 50 to 64.

03:38If enhanced subsidies lapse, average premiums for a 64-year-old with income of 401% of FPL

03:45will go from $5,328 in 2025 to $16,500 in 2026, according to KFF estimates.

03:56If Congress doesn't act, indeed, 2026 could look very different.

04:00In addition to the changes already noted, there will no longer be caps on repayment amounts.

04:06That is, the amount you have to repay, if it turns out, when you file your taxes,

04:10you got too big a subsidy.

04:12That's especially concerning for people with fluctuating incomes, such as gig workers

04:17and the self-employed, who could end up owing thousands of dollars at tax time.

04:22Currently, over 4.4 million self-employed persons and small business owners and employees

04:27receive tax credits that reduce their premium costs.

04:31In general, premiums will also go up.

04:34As the result of changes in the law, most marketplace consumers can expect to pay 4.5% higher premiums

04:40in 2026, even before the effect of reduced premiums.

04:45Those in the marketplace and those on employer-based plans could see an out-of-pocket cap that is

04:5015.2% higher in 2026 than it was in 2025.

04:56For full coverage, check out Kelly Phillips Erb's piece on Forbes.com.

05:02This is Kieran Meadows from Forbes.

05:04Thanks for tuning in.

05:10A perfect aid.

05:23Please take a great idea.

05:27Take care.

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