Texans enrolled in Affordable Care Act (ACA) health plans are bracing for significant financial strain as enhanced federal subsidies are set to expire at the end of the year. For many, especially those over the age of 45, this means monthly insurance premiums are projected to nearly double, forcing difficult decisions about their healthcare and finances.
The expiration of these subsidies, officially known as enhanced premium tax credits, is leading to an average premium increase of 35% across the state. However, the impact is far more severe for older individuals, who already face higher base rates due to age-related health risks.
Key Takeaways
- Enhanced federal subsidies for Affordable Care Act (ACA) health plans are expiring at the end of the year.
- Texans over 45 are experiencing the most significant premium increases, with some facing hikes of over 80%.
- Many individuals must now choose between paying much higher premiums, selecting plans with less coverage, or becoming uninsured.
- The loss of subsidies transforms affordable plans into major monthly expenses, sometimes rivaling mortgage payments.
A Looming Financial Crisis for Older Texans
For Groves resident Theresa Hebert, the numbers are stark. The 55-year-old property manager, who does not receive health benefits through her job, has relied on her ACA plan to cover extensive treatments for breast cancer over the past year, including four surgeries and numerous rounds of chemotherapy and radiation.
Her current plan costs $581 per month, made manageable by a $250 federal subsidy. With that subsidy gone, her premium is set to skyrocket by 87% to $1,091 a month. This new figure is alarmingly close to her $1,400 monthly mortgage payment.
"It’s not ideal," Hebert stated, reflecting on the impending financial pressure.
Hebert's situation highlights a broader trend. Health policy experts confirm that older enrollees are disproportionately affected by the premium hikes. Insurance companies set rates based on risk, and older individuals are statistically more likely to require medical care.
By the Numbers: The Subsidy Impact
According to an estimate from the Center on Budget and Policy Priorities, a 60-year-old Texas couple with an $85,000 income would have their annual premium for a silver plan capped at $7,225 with the enhanced tax credits. Without them, that same plan would cost an estimated $33,689 per year.
"Price impacts tend to hit older folks the hardest," explained Laura Dague, a health policy professor at Texas A&M University. "In general, they’re higher risk. That means that insurance companies have to charge them more."
The Difficult Choices Ahead
The open enrollment period, which ends January 15, has become a time of anxiety rather than routine planning for many. Consumers are faced with a set of undesirable options: absorb the massive cost increase, switch to a cheaper plan with higher deductibles and potentially lose their current doctors, or risk going without insurance altogether.
For those with ongoing health concerns, changing plans is not a simple decision. It could mean finding new providers, navigating different prescription formularies, and facing higher out-of-pocket costs before coverage kicks in.
G.W. Babb, a 63-year-old graphic designer from Austin, is another Texan caught in this dilemma. Thanks to subsidies, his monthly premium this year was zero. Next year, his insurer is raising the rate to $1,270. After losing about half his subsidies, his new monthly payment will be $870.
"Going from paying nothing to paying nearly $900 a month is insane," Babb said. "Even without all the subsidies, it’s still $400 a month more than what I’m paying right now."
To compound his problems, Babb's doctor of 20 years is not in the network of the plan he can now afford. Continuing to see his trusted physician will cost him an additional $150 per visit out-of-pocket, on top of the steep monthly premium.
Navigating a New Reality
Many older Texans are still years away from Medicare eligibility at age 65, leaving them in a coverage gap where they must rely on the ACA marketplace. The sudden removal of financial support has left them scrambling.
For Theresa Hebert, the uncertainty is overwhelming. When asked about her plan before the enrollment deadline, her response was simple and fraught with worry: "I have no idea. I have no clue."
Why Are Subsidies Expiring?
The enhanced premium tax credits were enacted under the Biden administration to make ACA plans more affordable during a period of economic uncertainty. These subsidies were not made permanent and were set to expire. Despite negotiations during recent federal budget discussions, an extension was not included in the spending plan passed by the Senate, allowing the credits to lapse as scheduled.
A Public Struggle on a Digital Stage
In an effort to process her anxiety and raise awareness, Theresa Hebert has been sharing her story on her TikTok account, @foolish_mortal999. Her posts about the looming insurance hikes have resonated deeply, attracting more viewers than even her posts about her cancer journey.
Her videos have become a real-time chronicle of the stress faced by thousands of Americans. She has used the platform to educate younger viewers who suggest she simply "go on Medicare," explaining she is still a decade away from eligibility.
She has also pushed back against critics who view the subsidies as a handout, reminding them of her 40 years of paying taxes. "Please forgive me for the whopping $250 in subsidies that I’ve received for the past 14 months even though I’ve never received literally any form of assistance in any aspect of my life," she stated in one video.
The increased engagement has had an unexpected side effect. The attention, both positive and negative, has pushed her follower count past the 10,000 mark needed for monetization on the platform. In a moment of dark humor, she mused that the income from her social media account might be the only way she can afford to keep her health insurance.
As the January 15 deadline approaches, individuals like Hebert and Babb represent a growing number of Americans facing a healthcare affordability crisis, forced to make critical decisions with no easy answers.
