How Americans Covered Through ACA Exchanges Are Navigating the Spike in Premiums
PBS NewsHour – November 20, 2025
As the year draws to a close, nearly 20 million Americans who rely on health insurance through the Affordable Care Act (ACA) exchanges face an imminent and potentially devastating increase in their healthcare premiums. Without congressional action to extend the enhanced subsidies introduced during the pandemic, many are bracing for premium hikes that could double their monthly costs — and in some cases, increase by over $1,000. ### The Stakes: A Cliffhanger for ACA Subsidies
During the COVID-19 crisis, lawmakers acted to expand and boost tax credits that made ACA marketplace coverage far more affordable for millions of families nationwide. However, these expanded subsidies are set to expire at the end of 2025. The failure to reach an agreement on their extension was a central issue in the recent government shutdown, with both Democrats and Republicans deadlocked on how to proceed.
According to the Congressional Budget Office (CBO), if no deal is reached, more than two million Americans may find the higher premiums and out-of-pocket costs unaffordable, leading them to drop their insurance altogether.
Voices from the Front Lines
PBS NewsHour correspondent William Brangham shared firsthand accounts from several Americans deeply concerned about these changes. Their stories highlight the human impact of the political impasse surrounding healthcare.
Crystal Akers of Bowling Green, Kentucky, a single mother, received notice that her premium was set to increase by more than $500 starting November 1. She credits marketplace subsidies for enabling her to maintain coverage but described the looming premium hike as “unmanageable” on her budget.
ReShonda Young from Waterloo, Iowa, who is battling breast cancer, emphasized how critical affordable insurance has been during her treatment. "Even with insurance, I’ve paid thousands out of pocket, but my premiums were affordable. Without the subsidies, my cost would jump from $94 to $592 a month," she said.
Tenika Mason of Dayton, Tennessee, shared that her family’s premiums could increase by $1,100 a month—a staggering 225% rise. With a daughter who is a brain cancer survivor and both parents requiring frequent specialist visits, Mason called insurance “not an option to forgo” despite the financial strain.
Melissa Ruff in Jacksonville, Florida recounted how the ACA allowed her to manage heart disease with essential tests and medications at minimal cost. Facing a premium increase from $238 to $1,308 monthly, she has reluctantly decided to go without insurance in 2026, raising concerns about access to care with her pre-existing condition.
The Broader Concerns
The individuals interviewed also expressed frustration with the ongoing political gridlock. Crystal Akers acknowledged the ACA as a positive step but criticized the instability of the program, which she believes makes it difficult for middle-class families to maintain coverage. ReShonda Young lamented the disconnect between lawmakers—many with generous government-backed health plans—and ordinary Americans who must choose between healthcare and basic necessities like food.
What’s Next?
As these stories illustrate, the expiration of enhanced ACA subsidies could result in a significant healthcare crisis for millions. Without congressional intervention before the end of the year, more Americans could find themselves uninsured just as health challenges continue unabated.
Viewers can watch the full segment on PBS NewsHour’s website and stay informed on this evolving issue by following continued coverage from trusted sources.
For more information and support:
- Visit the ACA Marketplace
- Contact local health insurance navigators
- Reach out to community health organizations for assistance
PBS NewsHour remains committed to providing trustworthy news and information on this critical healthcare story.
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