Tens of thousands of people are expected to go uninsured across Washington state if federal lawmakers do not extend tax credits that reduce the cost of Affordable Care Act health insurance.
Without these subsidies, freelance contractors, small business owners and others who rely on ACA plans will have to figure out how they will pay for health insurance in 2026.
Rebecca Staffel wasn’t feeling optimistic when she sat down at her dining room table on a recent afternoon to look over her family's insurance plan. She’s 57 and works as a marketing and documentary project consultant. She and her retired 63-year-old husband rely on a basic ACA plan to cover their medical expenses.
Without the subsidies, she initially worried they "could be going from paying $400 a month this year to almost $2,200 a month next year.”
Enhanced premium tax credits have helped many middle-income households purchase ACA insurance in recent years. In this case, those are households that make over 400% of the federal poverty level. The credits were created by Congress in 2021 and were later extended through 2025. The number of ACA enrollees that benefited from federal aid more than doubled over the last five years.
But these subsidies are set to expire at the end of December. Individuals who previously qualified for the tax credits could see prices surge, especially older enrollees, according to industry organizations like the health policy think tank KFF. Depending on the insurance plan, some households could see their monthly insurance bill more than double next year.
Staffel believed that she would no longer qualify for any help from the federal government and can’t afford to pay thousands of dollars a month for insurance. As a result, she considered abandoning her consulting business to look for a job that provides a health plan. She was willing to work in retail or serve coffee but was frustrated.
“It seems absurd that I would go work 30 hours a week as a barista for a low rate and then not be able to make the money that I can make as a consultant just so I can afford health insurance,” Staffel said.
Staffel also considered dropping her health coverage altogether. She and her husband are healthy, regularly exercise and don’t need to go to the doctor very often. They could potentially get by without insurance until they qualify for Medicare, the federal health insurance for people who are 65 and older or who are disabled.
“That’s the math, but in the end it’s a gut feeling: Are you willing to take this risk or not?” she said, “Obviously if something terrible happens, that could be bankruptcy.”
State health officials estimate that around 80,000 people in Washington will drop their health insurance if the ACA tax credits expire. More than 200,000 people across the state benefit from the subsidies and save on average about $1,300 annually on their insurance. According to Washington's insurance commissioner Patty Kuderer, losing the tax credits could eventually drive up insurance prices across the board.
“It’s typically going to be the stronger, healthier people that decide that they can afford to go without healthcare," she said. “You’re going to have a sicker risk pool overall, which means increased utilization, which will cause an increase in premiums.”
Kuderer’s office has approved higher rates for insurance providers that offer ACA coverage in Washington in 2026. Companies cited the expected loss of the tax credits along with rising medical costs and hospital consolidation as driving factors for the increases. Higher rates are expected to drive up the prices of ACA plans.
The enhanced premium tax credits have also become a driving issue in the ongoing federal government shutdown. Congressional Democrats are calling to extend the health subsidies, but Republican leaders have so far refused to address the issue before the government is reopened.
As that political drama plays out, people are preparing to sign up for or renew their ACA insurance plans during open enrollment, which began on Nov. 1 and ends on Jan. 15, 2026. Ahead of the new year, insurance brokers in Washington such as Gary Franke are preparing to help customers shop for medical coverage on Washington Healthplanfinder, the state’s ACA marketplace.
Franke is with Heffernan Insurance Brokers and specializes in ACA plans. Even though the loss of the enhanced premium tax credits would be catastrophic for many, Franke said some households will still qualify for more affordable plans.
“A lot of people think there is going to be no financial aid, and that’s simply not true,” he said.
The enhanced premium tax credits expanded financial aid access to households that have an annual income over 400% of the federal poverty level. For someone living in the lower 48 states in 2025, 400% of the federal poverty level was $62,600. For a two-person household it was $84,600.
If the ACA tax credits expire, subsidies for ACA insurance will only be available for households that have a yearly income at or below 400% of the federal poverty level. “If somebody makes above a certain level they’re not going to get any tax credits” and will have to pay full price for their health plan, Franke said.
Households that make less than 100% of the FPL do not qualify for these subsidies, but may qualify for Medicaid, the federal-state insurance program for low income households.
Washington Health Plan Finder provided estimates this year to help residents shop for insurance plans ahead of open enrollment that accounted for the expiring subsidies.
For Staffel, who expects she and her husband will make less than $84,000 next year, the state projected they would still qualify for financial aid. That means her monthly insurance bill shouldn’t dramatically increase even if the enhanced premium tax credits end.
That was a surprise — and a huge relief.
“Oh my gosh, this is a huge weight off my shoulders,” she said when she found out.
Staffel will still have to be careful. As a freelance consultant, her income fluctuates. Even though she should qualify for a more affordable insurance plan, if she makes too much money she’ll have to pay full price and pay back any subsidies her family received, which could cost her thousands of dollars.
Even though Staffel is excited that she won’t have to immediately drop her health coverage, she’s also frustrated. The uncertainty she faced while she considered the pros and cons of being uninsured was difficult.
“If it was this hard for me to figure out, imagine someone who is also juggling their kids with their freelance career or have to take care of their elderly parents,” she said. “This is too much.”
