Health care premiums to surge for Alabamians if Congress doesn’t reach ACA deal

Alabamians could see major surges in the cost of Affordable Care Act (ACA) plans without enhanced tax credits for ACA premiums, which lie at the center of the federal government shutdown.

According to a report from KFF, a nonprofit health policy research organization, ACA premiums are estimated to increase 114% on average nationwide.

An analysis by KFF found that most of ACA enrollees live in Republican Congressional districts and in states won by President Donald Trump in the 2024 presidential election. In Alabama, about 478,000 people, about 9.3% of the population, get insurance through the Affordable Care Act.

The number is about 10.5% in Alabama’s 1st Congressional District, represented by Barry Moore, R-Enterprise, and in the 2nd Congressional District, represented by Shomari Figures, D-Mobile.

Debbie Smith, the director of Alabama Arise’s initiative Cover Alabama, said in an interview Wednesday that while a 114% increase is the average, she has heard from Alabamians whose monthly premiums will increase by 980%.

“We also have someone who reported in from DeKalb County that her current premium is $35.33 and it will go up to $343 in 2026,” she said. “Almost 10 times the amount.”

She said another ACA participant in Geraldine, also in DeKalb County, who works at a small business will have a $636 monthly premium. In 2025, it was $363 per month.

For the most part, ACA enrollees in Alabama are employed, but their employers don’t offer insurance. Some are older enrollees who are not eligible for Medicare yet. She said the yearly premium for a 60-year-old couple making $85,000 per year will increase from $7,000 to $32,000 per year.

“That’s insane, $7,000 to $32,000, you might as well not even have health coverage at that point. And I’d say that’s a pretty moderate income for a household of two,” Smith said. “So where else are these individuals supposed to go?”

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The tax credit that Democrats in Congress want to keep allows anybody to purchase health care through the government. It was established by Democrats in 2021 as part of a COVID-19 relief package, and was extended in 2022 through the Inflation Reduction Act. They are set to expire at the end of 2025.

The possible loss of the premiums are at the heart of the federal government shutdown that began in early October. Republicans, who do not have the votes to overcome a Senate filibuster, want to pass a budget bill. Democrats said they will not pass a bill without an extension of the credits. Republicans say they will not discuss extensions until a budget bill is in place.

The tax credits currently allow those enrollees to have no premium in a silver plan, which has “moderate” deductibles, according to healthcare.gov. Smith said that 252,644 Alabamians fall in this category, about half of all Alabamians enrolled in the ACA.

“A lot more people being uninsured like that is not good for, obviously the people who are impacted, who don’t have access to healthcare, being able to see a doctor when they want to, but also for the system as a whole,” Smith said.

Without the enhanced tax credits, only Americans who make less than 400% of the federal poverty level will be able to purchase coverage. That is an annual income of about $62,600 for an individual and $106,600 for a family of three.

While Cover Alabama does not keep track of how many Alabamians enrolled in Obamacare make less than 400% of the poverty level, Smith said she is more concerned about those who make between 100% and 138%.

“If they lived in a different state, they would be on Medicaid. Since we haven’t expanded Medicaid, healthcare.gov, fills in the gaps for us big time,” Smith said.

Alabama Arise has advocated for Medicaid expansion for years, and it’s at the top of its 2026 legislative agenda.

This story is from alabamareflector.com.