North Carolina health care advocates and Democratic lawmakers warned this week that thousands of residents are facing sharply higher health insurance costs after enhanced Affordable Care Act (ACA) tax credits expired, a change they say is already pushing families out of coverage.
During a call with reporters, state Rep. Sarah Crawford and ACA navigators highlighted the financial impact of the lapse in federal subsidies, which they blamed on Republicans in Washington, including U.S. Senate candidate Michael Whatley, who they said has opposed extending the credits.
“Republicans in Washington, DC have created a health care crisis that has made costs skyrocket,” Crawford said. “They could have done something to fix it by renewing the ACA tax credits but on December 31st, they let them expire.”
The Affordable Care Act, signed into law in 2010 by President Barack Obama, expanded health insurance coverage nationwide and created tax credits to help reduce out-of-pocket costs for people purchasing plans through the federal marketplace. The law also prohibited insurers from denying coverage or charging higher premiums based on pre-existing conditions.
Today, more than 24 million Americans receive coverage through the ACA, according to health policy nonprofit KFF. In North Carolina, nearly one million people — about 10% of the state’s population — are enrolled.
Beginning in 2026, however, many ACA enrollees are expected to see significantly higher premiums due to a combination of rising insurance rates and the expiration of enhanced premium tax credits that were enacted during the COVID-19 pandemic.
State Insurance Commissioner Mike Causey has approved an average rate increase of nearly 30% for ACA plans sold through Healthcare.gov. Causey said the increases reflect rising health care costs as well as provisions in the One Big Beautiful Bill Act, which President Donald Trump signed into law in July.
At the same time, enhanced premium tax credits, which were expanded during the pandemic to increase financial assistance and extend eligibility beyond 400% of the federal poverty level, expired at the end of 2025. According to KFF, nearly 900,000 North Carolinians received the enhanced credits last year, with an average subsidy of $574 per month.
Advocates say the loss of those subsidies is already having immediate consequences.
“I have faced a number of health complications in the last year,” said Lea Charlton, an ACA tax credit beneficiary who saw her premium skyrocket. “When DC Republicans let the ACA tax credits expire and made my premium more than double, going without insurance simply was not an option. My premium skyrocketed from $975 a month to $1,945 a month.”
“My health should not be up for debate in DC. Michael Whatley wants us to send him to the United States Senate, but he supports letting the tax credits expire and sending premiums through the roof. When I pay nearly $2,000 a month and forgo critical care because I can’t afford it, Whatley is getting exactly what he wanted: High health care costs for working families.”
Amy Stevens, an ACA navigator who assists residents with enrolling in coverage, said she is seeing more people forced to drop insurance altogether.
“For the first time in all of my years doing this work, I am seeing something deeply troubling. I am watching neighbors, clients, and friends go without health coverage, not because they don’t need it, but because they simply can no longer afford it […] This should not be a political issue,” Stevens said.
An estimated 157,000 North Carolinians are at risk of losing ACA coverage in 2026 due to higher costs, according to a September letter sent by Gov. Josh Stein to federal lawmakers. Stein urged Congress to extend the tax credits, warning that both subsidized and unsubsidized marketplace enrollees would face steep increases.
“Too many North Carolinians risk either being priced out of health insurance entirely or paying exorbitant costs to continue to get essential health coverage,” Stein wrote.
Additional coverage losses are expected among recipients of Deferred Action for Childhood Arrivals (DACA), who will no longer be eligible for ACA plans or tax credits beginning in 2026 under the One Big Beautiful Bill Act. As of 2023, more than 22,000 DACA recipients lived in North Carolina.
Congress is expected to vote later this year on whether to extend the enhanced tax credits. For now, health advocates say families across North Carolina are already feeling the impact.
“We are here today because North Carolina families are losing health coverage right now – not in theory, not in the future,” Stevens said. “It’s a reality right now.”
