Ratepayers See Insurance Premiums Spike with Affordable Care Act Subsidies Set to Expire
Some Montana residents will face premium increases upwards of 200% as enhanced ACA tax credits near year-end expiration
By Zoë Buhrmaster
Every year, Marijke Stob has at least two doctor’s appointments – checkups that regularly include computed tomography (CT) scans, colonoscopies and bloodwork.
Stob had hardly seen the inside of a doctor’s office just a few years ago. Finding out she had colon cancer in 2023, however, changed everything. Stob underwent surgery and chemotherapy treatment, which successfully removed the cancer. Now, she’s on a strict schedule to monitor her body in case the cancer returns. Only recently did her number of appointments drop from four to two per year.
“I eat my vegetables and exercise, but my body decided to turn on me,” Stob said. “Now, I have to deal with that for the rest of my life.”
A self-employed seamstress, Stob’s insurance plan has a low premium and is subsidized with tax credits through the Affordable Care Act (ACA). Stob pays about $40 each month for coverage through Blue Cross and Blue Shield of Montana (BCBSMT). The low premium payments have allowed her to continue operating her gear repair shop in Columbia Falls and also be able to afford the expensive semiannual scans that her preventative care plan requires. In the fall, she also ran and won a seat on the Columbia Falls City Council, starting next year.
“So far things have been clear, but you never know with cancer,” Stob said. “Insurance is really, really critical, unfortunately, to me being healthy and making sure this disease doesn’t come back, and making sure we can catch it in time.”
When open enrollment for the federal health insurance marketplace began on Nov. 1, Stob went online to check out her coverage options for 2026 and saw that her premium for enrolling in the same plan had more than quadrupled – in large part due to ACA tax credits that are set to expire at the end of the year. Instead of paying about $40, she’d be paying just under $200 each month.
Stob’s monthly budget is usually about $2,000 per month, with an income that can fluctuate depending on the number of customers that enter her shop, Superbloom Gear Repair. That monthly budget enables Stob to run a business and cover all her personal expenses including rent, food, insurance and utilities – meaning that allotting nearly 10% of her income to insurance would be “kind of a big jump.”
“It’s going to max me out,” Stob said about the new proposed premium. “I don’t know what to do.”
ACA tax credits took center stage earlier this year during the 43-day federal government shutdown as Democrats refused to pass a continuing resolution that failed to include an extension of the expiring healthcare subsidies. A small group of Democrats ultimately approved the stopgap bill with a promise from Republican senators that there would be a vote on extending the tax credits by mid-December.
When health insurance open enrollment started Nov. 1, ratepayers like Stob saw spiking premiums that reflected a marketplace preparing for the subsidies to expire, among other factors.
In Montana, just over 77,000 people are currently enrolled in federal health exchange plans and 89% of those enrolled receive advance premium tax credits through the ACA, according to data collected by the health policy nonprofit KFF. Without those subsidies, those enrollees will see some of the highest insurance premium rate increases nationwide.
For a 40-year-old making 401% of the federal poverty level ($62,757 a year), the rate for a benchmark silver plan is estimated to increase by around 56%, resulting in an average monthly premium of $692. For a 60-year-old on the same income and same kind of plan, KFF estimates that those rates will increase by 231%, resulting in an average premium of $1,469.
Blue Cross Blue Shield spokesperson Amanda Douglas said that the company’s 2026 health insurance rates “reflect current market conditions including the expiration of enhanced premium tax credits, rising health care costs and utilization, and the likelihood that fewer people will be able to maintain coverage.”
“When enhanced subsidies expire, we expect enrollment of healthier individuals to decline at a disproportionate rate, increasing costs for those who remain,” she said. “BCBSMT complies with all applicable federal and state laws including, for individual plans, at least 80% of every premium dollar going directly to members’ care. We continue to support policy solutions that keep coverage stable and affordable.”
Everyone all the time is trading off how important is it to spend on health insurance and how important is it to spend on other things like food, housing, transportation. If the costs go up, that’s going to shift the priority for some people.
Katrina Mullan, UM professor of health economics
The enhanced tax credits, introduced in 2021 and later extended through 2025 by the Inflation Reduction Act, increased the amount of financial assistance that eligible ACA Marketplace enrollees could receive and raised the eligibility roof to make those with an income above 400% of federal poverty guidelines eligible for the premium credits. Marketplace enrollment more than doubled nationwide as a result.
“The issue that all of this was aiming to address was high premiums, especially for people with preexisting conditions,” Katrina Mullan, health economics professor at the University of Montana, said of the ACA Marketplace. “A result of high premiums is that there are high rates of uninsured individuals.”
If the subsidies expire, the Congressional Budget Office estimates nearly 4 million people would lose their insurance over the next decade. Large insurance coverage dropouts will likely include those with the lowest income, those between the ages of 50 and 65 who have a moderate income but don’t yet qualify for Medicare, and people who consider themselves to be healthy, Mullan said.
“If premiums are high and people can’t afford insurance, those who think that they are likely to have high [healthcare] costs will still tend to buy insurance, whereas those who expect to stay healthy will not,” Mullan said. “What that means is the pool of insured people are generally at higher risk and have higher costs, which means premiums have to be higher.”
A population with lower insurance coverage rates would likely mean less people engaging in preventative care, Mullan said, resulting in potential health concerns going unwatched and untreated, snowballing down the road into bigger issues. At hospitals, that would likely translate to more emergencies and more people who are less likely to be covered and able to pay, resulting in higher costs for the hospital and more medical debt for the individual.
“The problem is it creates a risk of catastrophic health costs,” Mullan said.
“Everyone all the time is trading off how important is it to spend on health insurance and how important is it to spend on other things like food, housing, transportation,” she continued. “If the costs go up, that’s going to shift the priority for some people.”
Last week, Politico reported the Trump Administration was working on a proposal to potentially extend the tax credits temporarily, one that could include raising the threshold to be eligible for the subsidies up to 700% of the poverty line.
President Donald Trump told journalists on Tuesday that “some kind of an extension may be necessary to get something else done,” noting that administration officials have been looking at other long-term options such as investing federal dollars in health savings accounts instead of insurance premiums.
With Congress expected to vote on ACA subsidies in mid-December, Montana’s delegation has said they oppose an extension of the tax credits. Both U.S. Sen. Steve Daines and Rep. Ryan Zinke called the healthcare system “broken” for the way it disproportionately benefits insurance companies, and U.S. Sen. Tim Sheehy said Congress should increase competition and transparency in healthcare.
Daines spokesperson Gabby Wiggins said that if there was a proposal to extend the subsidies by the White House, the senator would look forward to reviewing it.
“Not extending the subsidies will save taxpayers nearly half a trillion dollars,” Wiggins said Nov. 25. “Senator Daines is open to talks about ACA reforms now that the Democrat shutdown is ended and has been clear from the beginning that any future talk about changes to ACA subsidies must be linked to strong pro-life protections like the Hyde amendment.”
“The Obamacare bailouts in the form of taxpayer-funded subsidies allow insurance companies to continually increase premiums while reducing availability,” Zinke spokesperson Garrett Brown said. “It’s obvious that reforms need to be made to ensure healthcare is actually affordable and available to Montanans.”
Meanwhile, Stob is still facing a difficult decision over which healthcare plan to choose. Her other coverage options through the marketplace include a plan with a $10,000 deductible. With two CT scans in the books for next year in line with her preventative care plan, she would end up paying the full out-of-pocket max.
“I would hit that right away and I would be burdened to try and cover it myself,” Stob said. “I would be paying off medical debt for a long time with a payment plan through the hospital.”
Stob has until Dec. 15 to enroll in a plan in order to be covered starting on Jan. 1, or she can wait to enroll by Jan. 15 for coverage that starts Feb. 1.
“It’s quite infuriating, because I know I’m not the only one,” she said. “I guess it kind of comes down to that we’re all stretched thin.”
