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Premium increases are starting to hit home for millions of Americans as state-run Affordable Care Act marketplaces begin posting rates for next year that are based on the assumption Congress won't renew expiring financial assistance. Why it matters: Sticker shock could lead many Americans to conclude health coverage is out of reach while the government remains in a shutdown that centers on the fate of enhanced ACA subsidies that will sunset at year's end. Driving the news: "Window shopping," when ACA enrollees can preview their premiums for next year, is already underway in a half dozen states and begins Wednesday in California, Kentucky, Maine, New Mexico, Oregon and Vermont. In Idaho, the actual enrollment for 2026 coverage begins Wednesday. Signs-ups begin November 1 for the rest of the country. Democrats are already seizing on early examples of premium increases to prod Republicans to extend the subsidies. Sen. Raphael Warnock (D-Ga.) posted on X a potential premium increase, sent to him by a constituent, from $307 per month to $964 per month. The post has 6.5 million views. On average, premiums for roughly 22 million ACA enrollees will more than double without a subsidy extension, per KFF. What they're saying: Brad Woodhouse, president of the Democratic-aligned group Protect Our Care, said the group has created a toolkit to allow lawmakers to post examples similar to Warnock's and drive home the point that the pain has arrived. "I think after tomorrow when this window shopping starts to open, and you start to see this data trickle out, I think it's going to put Republicans in a tremendous bind," Woodhouse said Tuesday. The other side: Republicans say they are open to talks about extending the enhanced ACA subsidies in a modified form, but not as a precondition for reopening the government, as Democrats insist it should be. Asked if premium increases put pressure on Congress, Sen. Roger Marshall (R-Kan.), said "I'm more than happy, when the government gets open, I'll sit down with the Democrats" to talk about solutions."It was supposed to be related to COVID and it's become a boondoggle; it's a subsidy for insurance companies," Speaker Mike Johnson said of the enhanced tax credits on Monday. "If indeed the subsidy's going to be continued, it needs real reform," he added, saying the clean temporary government funding measure would allow time for those talks to happen over several weeks. Potential changes include income caps on eligibility, or a minimum premium payment to eliminate $0 premium plans that Republicans say fuel fraud. Between the lines: Democrats say that there is no time to wait, pointing to the November 1 start of ACA open enrollment. The office of Sen. Maria Cantwell (D-Wash.) highlighted window shopping data from neighboring Idaho to warn of premium hikes to come. For example, a single mom making $41,000 in Boise would see monthly premiums go from $69 to $215 without the enhanced subsidy.Red states are heavily represented in ACA enrollment, with Florida and Texas the top states for enrollees this year. Some Republicans in close reelection races next year have already come out in favor of a short-term extension of the subsidies. The bottom line: Sen. Ron Wyden (Ore.), the top Democrat on the Senate Finance Committee, told Axios "no question about it" more knowledge of premium increases among Americans will put pressure on Republicans. "People are coming to see that they have a health cost locomotive coming at them and it's going to crush them," Wyden said.
