Last week, the open enrollment period began for people to sign up for Affordable Care Act (ACA) health insurance plans offered through the marketplace at HealthCare.gov. But there was a nasty shock in store for those who went online to sign up for their 2026 health care plan. Compared to this year, the monthly payments for health insurance next year doubled.
Individual rates for everyone in North Carolina, whether they use a marketplace plan or get health insurance through their employer, will increase by 28.6% in 2026, slightly below the nationwide average increase. But that doesn’t tell the whole story. The amount North Carolinians pay out-of-pocket each month will increase further due to tax credits that currently help cover some or all of the costs expiring at the end of this year. Ultimately, millions of people across the country will see their out-of-pocket costs increase by 114%.
Insurance companies say that there are two main reasons the cost is increasing by such a big leap. Some of the increase is due to higher hospital costs, increased use of expensive drugs like GLP-1s, and higher drug prices across the board because of President Trump’s controversial tariffs. The other big reason is that, when Americans lose access to the affordability offered by ACA tax credits at the end of the year, companies predict millions of younger and healthier people will drop their insurance plans altogether.
Currently, nearly one million North Carolinians get their health insurance through the ACA.
For North Carolinians like Daniel Ayers, who is known to many as the face of the Hometown Holler, the ACA has especially been a lifesaver for those who needed affordable health care access in medical emergencies.
“I got injured. I needed knee surgery, and without the coverage I got through the ACA, I would not have been able to afford that care,” Ayers said.
The Affordable Care Act, passed in 2010, was a landmark law that required health insurance companies to cover pre-existing conditions, allowed states to expand Medicaid, and allowed children to remain on their parents’ health insurance through age 26. Republicans in Congress have attempted to repeal the law several dozen times.
In 2021, in response to the COVID-19 pandemic, Congress expanded a set of tax credits to help people afford their ACA insurance plans at a time when employment was fluctuating. Since the expansion of those credits, the number of people enrolled in ACA insurance plans doubled across the US, with the bulk of the improvement happening in the South.
In 2025, a record 24 million Americans enrolled in an ACA plan. If the credits are allowed to expire in December, conservative estimates are that 2 million people will lose insurance next year, and well over 2 million more will lose insurance by 2034.
When you include the number of people expected to lose health insurance by 2034 due to the Medicaid cuts in the “One Big Beautiful Bill Act” that Trump signed in July, it adds up to roughly 15 million people. Senator Bernie Sanders has repeatedly pointed to evidence that such a large increase in uninsured people would lead to an additional 50,000 preventable deaths per year.
The ACA tax credits and this major price increase were what began the federal government shutdown. Democrats introduced bills to fund the government and extend the ACA tax credits beyond this December, while Republicans crafted bills to only fund the government rather than prioritize the interests of the people.
The shutdown has become the longest in US history. Americans witnessed a new political low as the Trump administration targeted the SNAP food assistance program in order to pressure Democrats into voting for the Republican version of the bill to reopen the government without saving the ACA credits.
A small group of Senate Democrats broke from the rest of the party and voted for the Republican bill. As of Nov. 12th, the bill waits in the House, where Republicans hold a majority. The government will likely reopen this week. If that happens, there will potentially be a stand alone vote in December to extend the credits. Republicans have begun floating the idea that they will demand abortion restrictions for patients on ACA plans as the only way they will vote to save the credits.
