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In Oct. 2024, Paula Graham was diagnosed with breast cancer. Two months later, she had a mastectomy as part of her treatment. Graham had just enrolled in Affordable Care Act (ACA) health care coverage that year and called it “critical” to navigating her bills. “Even with insurance, it was very expensive, and so having the ACA availability and the subsidies really helped a lot,” Graham, a 63-year-old self-employed massage therapist in Virginia Beach, Va., told ABC News. Graham’s premium is currently $258 per month after the ACA tax credit is factored in. Her max out-of-pocket expense is $6,400. Next year, however, she could see those figures skyrocket. “If the subsidy continues, my monthly premium will be $453 a month. But if the subsidy does not continue, it'll be $1,018 a month," she said. Her out-of-pocket max would also jump an additional $600, according to Graham. “If the subsidy is not there, you know, having a $1,000 premium per month, you know, that's like, close to a housing cost, you know, it's like, not that much less than my house payment," Graham said. “It's as basic as food," Graham said of health care. "We all need to have access and people should not go bankrupt for having a cancer diagnosis or an accident, or – it just shouldn't be. I just don't understand it." Graham isn’t alone in dreading what an end to ACA subsidies would mean for her health care costs. A new analysis from KFF found that if the enhanced premium tax credits expire, as they are currently set to do on Dec. 31, ACA enrollees will see their monthly premiums more than double – rising by roughly 114% on average. The ongoing federal government shutdown has prevented Congress from voting to reauthorize the ACA premium tax credits. There have so far been 13 failed votes in the Senate to reopen the government. Democrats have refused to vote on a short-term funding bill that doesn't address the issue of extending the ACA subsidies, and Republicans have said they won't address the issue without Democrats first voting on a bill to re-open the government. An estimated 22 million out of 24 million ACA marketplace enrollees currently receive a tax credit to lower their monthly premiums. But even if those credits are extended, KFF found that the amount insurers charge for ACA premiums will rise by an average 26% in 2026. Just a year after her diagnosis, Graham said she feels she has no choice but to keep her coverage while adjusting her budget to accommodate the increased costs. “I will dig in and do what I have to do and keep my coverage,” she said. “Maybe we won't go out to eat, less entertainment … I always try to support local businesses where I can and I won't necessarily be able to do that. … We always try to help where we can, but that will get cut back.” Graham said she wants Democrats to “hold the line” on insisting that ACA subsidies are addressed, but that both parties need to "come to the table and talk." “I know everybody's got a little blame here, but they need to talk," she said. "They all need to get together and talk.”
