As open enrollment for health insurance begins this Saturday, many Californians are facing shocking increases in their premiums. For Tara and Todd Nicklous, their monthly health insurance premium through the Affordable Care Act will leap from $923 to an astonishing $3,264 next year. This news has left them both stunned and anxious about their financial future.
The Nicklouses, who operate a real estate appraisal business, benefited from expanded tax credits under the Affordable Care Act during the COVID-19 pandemic, a policy initiated by former President Joe Biden. These credits, designed to make health insurance more affordable, are set to expire at the end of 2025 amid ongoing negotiations in Congress regarding a federal government shutdown. Democrats are demanding an extension of these credits, while Republicans are withholding support until the government reopens.
Tara Nicklous, who is undergoing treatment for a blood cancer, expressed her concern, stating, “My gut sunk.” The couple had saved diligently to manage their health insurance costs, but they are now facing the prospect of severe financial strain. “We’re hunkering down,” Tara added, emphasizing the adjustments they will have to make in their spending habits.
Rising Premiums and Coverage Losses
Recent figures from Covered California, the state’s health insurance marketplace, reveal that most of the 2 million Californians relying on this exchange will see their premiums double on average, with some experiencing increases of up to three times their current costs. The implications of this change will be particularly severe for middle-income residents who had previously benefited from the expanded ACA tax credits.
According to a report by the Urban Institute, approximately 400,000 Californians may lose their eligibility for Covered California due to these changes, with an estimated 175,000 individuals likely unable to afford any insurance coverage at all. This situation is expected to lead to significant health care access issues, especially for those in their 50s and 60s who have yet to qualify for Medicare.
Representative Eric Swalwell, a Democrat representing the East Bay, attributed the premium spikes to Republican actions. He stated, “For weeks, Democrats have been warning that leaving health care out of this funding bill would raise costs for millions of Americans. Now, those consequences are becoming reality.”
State Assistance and Future Challenges
In light of the impending expiration of federal tax credits, California officials plan to provide limited assistance. The state intends to allocate about $200 million in tax credits to low-income residents earning slightly above the threshold for Medi-Cal, California’s version of Medicaid.
As the open enrollment period runs from November 1 through January 31, Covered California has begun notifying enrollees about the upcoming cost increases. Premiums for 2026 are expected to rise by an average of 10%, largely attributed to the escalating costs of care and the increased use of expensive medications like weight-loss drugs.
Kaiser Permanente, California’s largest private insurer, announced a 7.1% increase in rates for Covered California plans. Although a spokesperson noted that this increase is relatively lower than those imposed by many competitors, the impact on consumers remains significant. Another major insurer, Anthem Blue Cross, is set to raise rates by 14.5%, citing that enrollees are already relying on emergency room services at a rate twice that of those with employer-sponsored health plans.
John Murphy, chief medical officer at La Clínica de La Raza, highlighted the broader implications of rising premiums. He noted that as costs increase, patients tend to delay preventive care, which can result in more serious health issues that ultimately require emergency interventions.
For the Nicklouses, the financial burden of skyrocketing premiums means making difficult lifestyle adjustments. Tara remarked on the impact this will have on their daily lives, saying, “We’re changing our shopping and our eating habits. I’ve never been such a Walmart and Costco shopper. Vacations? Forget it. Maybe camping.”
As the situation unfolds, the future of health insurance for many Californians hangs in the balance, reflecting larger national debates on health care policy and access.
