Some Arizonans rethinking Obamacare coverage over 2026 sticker shock

Open enrollment for federal Affordable Care Act health insurance started Nov. 1 but fewer Arizonans may sign up for 2026 plans because of higher prices that will be too costly for some people. 

“The prices are the biggest change,” said Claudia Maldonado, director of outreach and enrollment for the Arizona Alliance of Community Health Centers, which helps Arizonans enroll in Affordable Care Act coverage, also known as Obamacare. “We might see fewer people enroll.” 

President Donald Trump on Nov. 12 signed a deal to end the 43-day federal government shutdown, but the agreement did not include a sticking point for Democrats — an extension of the enhanced federal premium tax credits that were put in place by President Joe Biden in 2021 amid COVID-19-related unemployment and economic stress. 

The Senate is expected to vote on whether to extend the subsidies in December, but there's no guaranteed outcome and the House of Representatives has not scheduled a similar vote, Reuters reported. 

About 423,000 Arizonans signed up for ACA coverage for 2025, but with enhanced federal subsidies that help pay for coverage set to expire at the end of this year, Maldonado said that for some current enrollees that means “prices are going up quite a bit.” One Scottsdale couple says their annual ACA costs are set to go up by $20,000, though they appear to be among a smaller group seeing such extreme sticker shock. 

Some say enhanced ACA subsidies were supposed to be temporary 

The enhanced tax credits both increased the amount of federal financial assistance already eligible ACA Marketplace enrollees received as well as made middle-income enrollees with income above 400% of federal poverty guidelines newly eligible for premium tax credits, according to KFF, an independent health policy research, news and polling organization. 

A lack of resolution on the subsidies has some Arizonans hopeful that they'll be extended, so they are waiting before renewing their ACA plans or signing up for new ACA coverage, Maldonado said. Open enrollment goes through Jan. 15, though anyone who wants their 

coverage to start Jan. 1 needs to enroll in coverage and pay the first month's premium by Dec. 15, she said. 

Republicans are primarily opposed to extending the enhanced subsidies because of cost, but there are other reasons too. They argue that the enhanced subsidies were always supposed to be temporary, and many Republicans already dislike the ACA. The Congressional Budget Office has estimated that making the enhanced subsidies permanent would cost the federal government $335 billion over 10 years. 

Democrats want to keep the enhanced subsidies in place because they make health insurance more affordable for millions of Americans. Various studies have projected millions more people will become uninsured if the enhanced subsidies go away — 4.8 million in 2026, according to an Urban Institute study that is one of the higher estimates. 

Robert Kaestner, a research professor at the University of Chicago’s Harris School of Public Policy, says that the partisan debate around the enhanced tax credits has led to exaggerated claims on both sides of the issue. Kaestner thinks the estimates of 4 million or more Americans losing health insurance are overstated. He places the number at about 2 million people, which is still a serious cost, he said, and said there are drawbacks no matter what happens. 

The price of ending the expanded subsidies is that some people will go without health insurance because of the higher expense, he said. The benefits of ending the expanded subsidies, according to Kaestner, is that government expenditures are better targeted toward people most in need. 

“From 2020 until today, there's 20 million more people on Medicaid and in the ACA marketplaces, meaning 20 million more people getting government subsidies for their health insurance,” Kaestner said. “If we look at what happened to the uninsured rate, there’s no evidence that 20 million came from the ranks of the uninsured. So while I can’t be sure about this, many of that 20 million came from private insurance.” 

It's possible the public side is picking up the slack for a decreased availability of employer-sponsored insurance, Kaestner said, or it could be that people saw how much they could save on public plans and they are switching voluntarily. 

“That’s an important distinction. If a lot of them, especially the people with higher incomes — there’s a couple of million at more than 400% of the federal poverty level on the ACA marketplace — if they really have access to other health insurance and aren't really the group in real need, then saving the government subsidies for them (by allowing the enhanced subsidies to expire), saves the government money.” 

Up to 150,000 Arizonans could lose coverage without enhanced subsidies 

The sticker shock for 2026 is a reality for some people who want the same level of coverage. But use of words like “double, triple and quadruple” in reference to 2026 premium increases is misleading, according to Kaestner, because there is an option to drop down to a lower-tier plan with less generous coverage if they want to save that money. 

“Clearly the expanded subsidies save people money. … The ending of the subsidies is going to increase how much they pay for their current heath insurance plan,” Kaestner said. “Certainly people are going to need to spend more, or if they don't want to bear the premium increase for their current plan, drop down to a less generous (high deductible) plan.” 

A mother and two children with an annual household income of $40,000 per year will have to pay about $1,500 or $1,600 more per year in 2026, he said, or 4% of her income — that’s the more typical scenario, and for many people that is not a trivial number, he said. 

Some people will end up uninsured. Dr. Daniel Derksen, director of the University of Arizona's Center for Rural Health, estimates 125,000 to 150,000 more Arizonans will be without health insurance in 2026 if the ACA's enhanced tax credits are allowed to expire. 

“The reason to continue it is because you are trying to make it so that people aren’t paying such a large percentage of their income just to get health insurance,” Derksen said. “It’s a sliding scale. It’s not free. There’s been some misinformation out there that people making $600,000 a year are getting free health insurance through the Affordable Care Act and that’s just not true.” 

After Biden put the enhanced subsidies in place, enrollment in ACA coverage enrollment in plans nationwide more than doubled from 11 million to 24.3 million, federal data shows. The numbers also more than doubled in Arizona, with enrollment jumping from 154,504 in 2021 to 423,025 in 2025. About 90% of current Arizona enrollees receive federal subsidies to help pay for the private insurance they purchase from the ACA marketplace. 

Eric Kurland, 61, and his wife, Kari Kurland, 63, are among the Arizonans who purchased ACA coverage after 2021, when subsidies made the insurance more affordable. The retired Scottsdale Unified School District teachers are paying $513 per month or $6,156 per year for their bronze level ACA insurance, which has a $12,000 annual deductible. The ACA marketplace prices health insurance in metal tiers, with gold being the most comprehensive, and also the most expensive premiums. 

For 2026, Kurland says the cheapest available bronze level plan will cost the couple $2,218.69 per month or $26,624.28 for the year. Their combined income is about $80,000 per year, he said. The couple has decided not to purchase ACA coverage for 2026, though they do have another option — buying health insurance through the state retirement system. Kurland estimates that will cost about $1,000 per month or $12,000 per year, which is nearly double what they pay now. 

“It is somewhat of a solution, which will cause us to cut back a little bit,” Kurland said. “I feel the Democrats have given up the fight and I think they need to fight and I am upset with them.” 

Phoenix resident, 40, looking at lower-tier plans due to 2026 costs 

Robert Hess III, who owns a Phoenix health consulting business and is currently enrolled in an ACA plan, briefly considered going without health insurance when he looked at 2026 prices. But Hess, 40, knows what it’s like to be uninsured — he had strep throat while uninsured in 2007 and did not seek medical care until the infection was so bad that he ended up in an emergency room with kidney damage and now has a chronic kidney condition that requires medication. 

Since he’s self-employed, Hess doesn’t have employer sponsored health insurance, makes too much money to qualify for Medicaid, which is a government health insurance program primarily for low-income people and people with disabilities, and he’s too young for Medicare, which is a government health insurance program primarily for people over the age of 65. That’s why he’s been getting coverage through the ACA marketplace since 2015. 

Hess has a silver plan now that’s $334 per month, which includes a federal subsidy, with a $7,500 annual deductible. Prices for his age and income level for 2026 are higher, with premiums nearing $500 per month for a silver plan, which is why he’s probably going to purchase a bronze or catastrophic plan. Lower tiered plans have lower premiums but higher out-of-pocket costs, and he’ll hope that he doesn't get seriously ill or have an accident, but at least he’ll have coverage if he does, he said. 

Maldonado expects to see more Arizonans choosing bronze plans if the enhanced tax credits aren't extended and she emphasized that free assistance is available for anyone who needs help choosing a plan and understanding their options. Arizonans may call Cover Arizona at 800-377-3536 or go online to coveraz.org/connector, and enter their ZIP code to find the nearest navigator who can help. 

UA expert: Enhanced subsidies 'really for people in lower income brackets' 

Families like the Kurlands are not a group that was targeted for subsidies in the first place, and represent a “very small group of people” who are seeing such drastic price hikes for 2026, the University of Chicago's Kaestner said. Most people in the Kurlands’ position have access to other health coverage, he said, and health care costs are rising. 

“The cost of health care has been going up for private, employer-sponsored insurance, for Medicare, for the ACA marketplaces. It just costs more because we are inventing things like GLP-1 drugs. The quality and the expense of care has gone up and that’s not necessarily a bad thing if it saves our lives,” he said. 

Even though health care is expensive, no one should be going without it in order to pay for groceries other necessities, the University of Arizona's Derksen said. 

“We just had through HR1 (the One Big Beautiful Bill Act) a huge tax credit essentially for people in the top income brackets,” Derksen said. “This (enhanced ACA tax credits) is really for people in lower income brackets. It just makes sense to make it affordable. It makes no sense to throw 125,000 to 150,000 people off of health insurance.” 

Employer-sponsored health insurance is exempt from taxes, he said and a large percentage of Americans and Arizonans get health insurance through employer-sponsored insurance. 

“It kind of strains credulity to think we can’t give a tax credit to people with lower incomes so that they can afford health insurance,” Derksen said. “Whatever side of the aisle you are on, this is going to affect Democrats, Republicans and Independents.” 

This article was originally published by the Arizona Republic