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.
05:27Take care.
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