West Virginians on expanded enrollment for health insurance under the Affordable Care Act are about to get sticker shock.
About 50,000 to 60,000 West Virginians will see higher prices as open enrollment begins without an extension of subsidies through the federal government. West Virginia is expected to be hit hard, possibly seeing some of the largest rate increases in the country.
The open enrollment period starts Nov. 1, Saturday. People logging on for open enrollment will be faced with significantly higher costs, affecting more than 20 million Americans enrolled in marketplace plans.
The average consumer is likely to see out-of-pocket payments more than double, according to a recent analysis from KFF, a health research group.
“This week, 60,000 West Virginians are seeing for the first time how much Congress’ inaction will cost them next year,” said Kelly Allen, executive director of the West Virginia Center on Budget and Policy.
“Families who get their health coverage on the Marketplace are seeing their premiums for 2026 doubling, tripling, and in some cases increasing ten-fold, with the expiration of enhanced premium tax credits—with West Virginia among the states most impacted in the country.”
Allen explored the window shopping function on healthcare.gov, the ACA Marketplace, that allows consumers and the public to get an advance look at the prices for open enrollment. Her analysis found that households of all sizes and incomes will see their monthly insurance premiums spike dramatically.
The subsidies themselves are scheduled to expire Dec. 31. Debate over extending them has been a key aspect of demands by congressional Democrats as the federal government continues to be shut down.
The Affordable Care Act dates back more than a decade now. In 2021, Congress passed enhanced tax credits, making it more affordable to buy coverage.
Since the increase, the ACA marketplace saw a significant surge in enrollment. Enrollment was 10 million to 11 million people four years ago, and now it is more than 24 million.
Many of the people taking advantage of the ACA subsidies include small business owners or people who work for small employers.
“These are retirees, entrepreneurs, and small business owners and their employees,” Allen said.
“For many, they will be forced to choose between maintaining health coverage and paying their bills. While it’s not too late for Congress to act, every day wasted will result in more West Virginians making painful choices to forgo health coverage altogether.”
The legislation that prompted the enhanced subsidies came with an expiration date.
The enhanced benefits were originally expanded through the end of 2022 as part of the American Rescue Plan, a covid-era relief package. West Virginia’s Senator Joe Manchin, at the time a key vote, agreed to a three-year extension as part of the Inflation Reduction Act of 2022.
Initially, Manchin expressed reluctance to extend the enhanced subsidies, citing concerns about inflation. He also suggested he wanted the financial aid to be subject to stricter means-testing.
So that’s the short story of why the subsidies extension has returned as a big tangle now.
The issue is intertwined with the continuing resolution that Congress is considering to keep the government open after the start of the new fiscal year. In exchange for support for the continuing resolution, a key demand by Democratic leaders is an extension of the subsidies.
The cost of permanently extending the enhanced subsidies is estimated by the Congressional Budget Office to be about $350 billion over a decade.
Jeremy Smith, an Affordable Care Act navigator for First Choice Health Systems, spoke about the situation with WMOV Radio.
“The enhanced tax credit made the plans much more affordable. We’ve grown the marketplace from about 20,000 West Virginians in 2020 to almost 70,000 today. So there’s been a big growth, and a large part was because the plans were more affordable,” he said.
“But starting this open enrollment period those enhanced subsidies are set to expire. So all of the subsidies will revert back to the same levels we saw in 2019 and 2020, meaning that a lot of people will see some sticker shock when they log in to renew their plan this year.”
The open enrollment period starting right now will reflect plans without the subsidies in place.
“What you’re going to see is how much it’s going to cost without those extra subsidies in place,” Smith said, “and a lot of people are going to have to make decisions based on what they’re seeing right now.”