Democrats keep shutdown going to save health care subsidies
Health care has been in the national spotlight amid this government shutdown.
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As the federal shutdown drags on, Republicans accuse Democrats of prolonging it for political reasons, pointing to stalled votes that could reopen the government and fully restore programs like SNAP. But Democrats say what they’re holding out for isn’t politics — it’s protection. Specifically, protection for millions of Americans who rely on Affordable Care Act subsidies that will soon expire.
The enhanced subsidies, introduced by President Joe Biden’s American Rescue Plan Act in 2021 and extended by the Inflation Reduction Act in 2022, have kept monthly insurance costs low for families who don’t qualify for Medicaid or employer coverage. Unless Congress acts, those subsidies will expire at the end of 2025.
That would mean smaller tax credits, stricter income eligibility and a return of the so-called “income cliff,” leaving many moderate-income households in Western North Carolina exposed to rising premiums.
In the meantime, insurers have already signaled what’s coming next. According to filings with the North Carolina Department of Insurance, Ambetter of North Carolina has requested a 25.6% rate increase for 2026, AmeriHealth Caritas a 36.4% increase and Blue Cross Blue Shield — with more than 400,000 customers in the state — a 29.4% increase, all before subsidies are applied.
Jessi Stone, regional director of Pisgah Legal Services’ health and economic opportunity program, said she’s already hearing from clients across the mountains.
“It’s really going to be people in those middle-income tiers,” she said. “If you’re under 138% of the federal poverty line, you’re on Medicaid, so nothing has changed there. But for people above that, especially those earning around $60,000 a year, they’re going to see a huge decrease in their premium tax credit and will have to pay more on the marketplace.”
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Stone said she’s been testing scenarios through healthcare.gov to illustrate how rising premiums intersect with shrinking subsidies.
“I typed in a 40-year-old male making $40,000 a year,” she said. “The subsidy for last year was $416 a month. For 2026, that subsidy is showing up at $402. So really not a huge difference in the subsidy — but when you go to look at the plans, the plans have gone up significantly.”
For the same plan from Ambetter, Stone said, the out-of-pocket cost will jump from $41.71 to $130 a month.
“Insurance companies are looking at it as, ‘Okay, the enhanced subsidies are going away, so fewer people are going to enroll through the marketplace,’” she said. “So they increase their prices to make it advantageous for them. That’s an assumption, but that’s what we’re seeing.”
That shift could hit older adults especially hard — those nearing retirement age but not yet eligible for Medicare.
“For a 63-year-old making $60,000 a year, they’re still going to get an $1,100 subsidy a month,” Stone said. “But if they’re making $65,000, they’re above 400% of the federal poverty level, and they’re no longer eligible for a subsidy. They’d have to pay full price, which could mean $1,000 a month with a $10,000 deductible.”
Many of those who do qualify still face tough choices in rural counties where provider networks are limited.
“The more rural you are, the fewer insurance options you have,” she said. “A lot of people like to stay on Blue Cross Blue Shield because it’s got the largest network. But Blue Cross plans have gone up significantly this year, so there might be a lot of people that need to look at other options.”
While the subsidy change hasn’t taken effect yet, Stone said confusion and anxiety are already rising.
“Open enrollment officially starts tomorrow,” she said Oct. 31. “So we haven’t enrolled anyone in a 2026 plan yet,” she said. “But with all the news about the government shutdown and the subsidies, people are calling us asking how this might impact them. We’re just trying to give them the most information we can and prepare them for an increase.”
She added that insurance company participation fluctuates from year to year, further complicating choices for consumers.
“This year, Aetna CVS is no longer in the marketplace,” she said. “A lot of people assume it’s because Aetna got the state employees insurance contract. We anticipate a lot of people coming back this year needing help picking another plan, since Aetna is no longer an option.”
Nicholas Riggs, director of Legal Aid of North Carolina’s NC Navigator consortium, which counts Pisgah Legal as a member, said that philanthropic support has helped the organization weather a 90% cut in federal navigator funding that has left the organization at 75% of prior navigator capacity.
“It wasn’t as catastrophic, as far as our capacity levels, as it could have been,” Riggs said. “If anything, we’re very grateful for that philanthropic support and we’re focusing on volunteer navigators.”
Pisgah Legal Services is also expanding its navigator program to meet demand.
“We’ve just brought on 10 new volunteers to be navigators, and we’ve trained them,” Stone said. “Appointments can be over the phone or in person. We also have different language services and interpreters. People just need to call us and make an appointment.”
The organization also offers free tax preparation, which helps clients reconcile premium tax credits at the end of the year.
“Come tax season, the last thing we want to see is people having to owe back those premium tax credits because they didn’t know,” she said. “When you’re applying in November or December, you’re estimating your income for the next year, and people can update that anytime. But a lot of people don’t.”
Stone said the end of subsidies could ripple far beyond households and into the region’s fragile healthcare infrastructure.
“Our federally qualified health centers like Blue Ridge Health and Appalachian Community Services are already struggling to meet the need of people who are uninsured or underinsured,” she said. “The more people who can’t afford coverage will become uninsured and will need to rely on those centers again. That means increased wait times and higher emergency room costs that hospitals have to absorb.”
That dynamic, Stone believes, threatens to reverse the gains made since the ACA took effect more than a decade ago.
“It does feel like all the work that’s been done to improve the system — they’re working to tear that down,” she said.
Pisgah Legal has seen similar stress among Deferred Action for Childhood Arrivals recipients. They were newly eligible for ACA coverage last year, but lost that eligibility under a bill passed this summer.
“We’ve had several DACA recipients call us for help canceling their plans because they’ll no longer be eligible for the premium tax credit,” Stone said.
When asked what she would tell policymakers in Washington, D.C., about the real-world effects of the subsidy fight, Stone didn’t hesitate.
“The bottom line is, it hurts our economy in every aspect,” she said. “ACA has really allowed for a more diverse economy, especially in rural Western North Carolina, where there’s not a ton of corporate jobs. People can move here, work remote, and not having affordable insurance provided through these premium tax credits really hurts that population.”
Stone said she worries that negative headlines could discourage people from even exploring their options.
“I worry that people are going to think it’s not even worth looking at,” she said. “If your income is fairly low or you have a family, there could still be a lot of options. It’s always worth looking.”
For now, the shutdown continues, with Democrats holding firm and Republicans demanding an end. Between them stands a policy that determines whether affordable health care in rural America remains accessible — or slips further out of reach.
