Mass notifications announce ACA exchange insurance rate hikes

With extension of the subsidies at the heart of the stalemate behind the government shutdown, specifics on the size of the premium increases could add new pressure on Congress.
The subsidies were introduced in an expansion of the ACA in 2021. Democratic leaders want to make the subsidies permanent, but Republicans have declined to consider that until Congress authorizes new funding to reopen the government. The expanded tax credits doubled participation in the ACA exchanges over the past four years, and while their expiration wouldn’t end all of federal subsidies for health insurance, it would reduce support back to 2021 levels.
The 2021 legislation made subsidies more generous and extended them to a larger number of people. In Massachusetts, some 337,000 people benefited from the federal subsidies that made health insurance more affordable through the connector.
Losing the subsidies could play a role in increasing the number of uninsured people in Massachusetts by roughly 300,000 over the next decade, officials have said.
On average, the loss of the expanded subsidies will trigger double-digit increases in for people in most eligible income brackets, according to the connector. Those averages, though, obscure a wide range of increases that vary depending on location, family size, and type of coverage. Almost 20,000 Massachusetts residents would no longer get any subsidized insurance at all, said Alex Sheff, senior director of policy and government relations at Health Care For All, a Boston-based health advocacy organization.
“There are particular groups that are going to see these really astronomical cost increases,” Sheff said.
Judith O’Gara, a part-time editor at community newspapers, and her husband, a self-employed computer animator and mural artist, were notified this week that their monthly premium would increase by $435. A cheaper plan would likely offer higher copays or premiums and would still be $200 more. It’s less than she feared, but still a burden. She hopes, but isn’t certain, that she could get insurance through her employer if she works more hours. If not, she must make difficult choices.
“It’s not great to be presented with rising costs and $200 to $400 a month at the same time the cost of food was rising, the cost of oil is rising, the cost of electricity is rising,” O’Gara, 56, of Millis, said.
The premium notifications in Massachusetts may give some exchange customers sticker shock, said Matthew Fiedler, a senior fellow at the Brookings Institution, a centrist Washington policy think tank. They may decide they can’t afford to renew their insurance, and stick with that decision even if the subsidies are saved.
“We are getting to the point where the fact that the subsidies have not been extended will have actual consequences for who has health insurance and who doesn’t,” Fiedler said.
Lidia Pruente, of Dorchester, recalled first receiving her notice from the connector this week.
“My first reaction was definitely dread, but I think things might not be as bad as I currently feared,” said the 35-year-old.
Her premiums would increase by $70 a month in 2026, she said. The increase comes as she also faces higher costs for compression leggings and shorts and bandages she needs to manage swelling in her legs and abdomen caused by lymphoedema, a chronic condition that causes fluid to build up in parts of her body, she said.
“$70 plus a ton more in durable medical equipment, that would be a challenge,” said Pruente. “It’s very stressful to know this is what health insurance costs.”
But for some, the rate increase looks to be manageable. Sara Hamlen, a Boston resident who works in catering, was notified that her premium would increase by just $12 a month.
The 61-year-old said the subsidized insurance is a lifesaver as she manages a year of bills with seasonal employment.
“I’m just treading water,” she said.
The White House did not reply to a request for comment Wednesday.
The notifications drive home the point that, “nobody is coming out ahead as a result of the Republican cuts,” said Massachusetts Senator Elizabeth Warren in an interview Tuesday. “The only question is how much higher people’s insurance premiums will be.”
Insurance through ACA exchanges nationwide is expected to increase by a median of 18 percent next year, KFF, a health policy analysis foundation, reported. That is in part driven by the expected end of the expanded subsidies, but also increases in medical costs and prices in general due to the Trump administration’s tariffs.
Massachusetts began sending out notifications of premium increases last week, and will continue notifying customers through the end of the month, according to the Connector. The state is one of 19 that, along with the District of Columbia, run independent ACA insurance exchanges, according to the Centers for Medicare and Medicaid Services. The other independent exchanges are expected to send similar notifications, Fiedler said.
Nationally, about 70 percent of people insured through the exchanges use a federal marketplace operated by CMS, said Fiedler. They may have to wait until that agency posts rates for 2026 on its website before Nov. 1, when the open enrollment period for insurance begins, CMS said in a statement Wednesday.
Until now, the government shutdown has been driven by estimates of the cost of the expiring subsidies. The information released now by Massachusetts is among the first to put a number to premium increases, said Fiedler, of the Brookings Institution.
“It hasn’t necessarily been individuals being told, ‘here’s what’s happening to your premiums next year,’” he said. “The conversation is about to change.”