If you’ve been playing ostrich and hiding your head in the sand on the subject of health insurance, you’re not alone. What’s happening in health-care costs is chaotic and concerning. Peering into the crystal ball for 2026, the picture that emerges, as Jan. 1 approaches, is that it seems most likely that many New Yorkers’ health coverage is in real jeopardy. It’s time to face the truth that bad things may be happening soon to insurance costs for many of us.
Do you buy your insurance yourself through the New York State marketplace? Or, do you qualify for an Essential Plan that helps you pay far, far less for health insurance through the State of Health? It’s time to shake yourself out of your ostrich oblivion. Both of those scenarios are funded by enhanced Affordable Care Act subsidies. If you are in a middle-income bracket, and buy your insurance in the marketplace, your lower-than-market-rate premiums are supported by Obamacare. And if you are very low income, your zero premiums are, too. Around 24 million Americans are able to afford health insurance through the A.C.A. Thanks, Obama!
The battle over A.C.A. subsidies is why Congress shut down this fall. Democrats on the Hill want to extend the subsidies for another three years; most Republicans do not. (Though some Republicans in vulnerable seats in swing states are banging the drum that political danger lies ahead if some other magical arrangement to reduce premiums isn’t put into place. They’re proposing a third way, involving special savings accounts for health insurance. It’s convoluted.) We don’t know yet how this subsidy debate will shake out, but things are looking grim.
Meanwhile, the Big Beautiful Bill (H.R. 1) — already passed by the G.O.P. last summer — has created a second funding crisis for Americans’ health insurance. According to the New York State Department of Health, H.R. 1 “eliminates $7.5 billion in annual funding for New York State’s Essential Plan, jeopardizing health care coverage for the nearly 1.7 million low- and middle-income New Yorkers who are currently enrolled in the program.” The upshot is that nearly half a million New Yorkers on Essential Plans are in for a horrible shock come July 1, when they lose their low-cost insurance. The State Legislature, in response to this federal funding bloodbath, has set that date as the moment when income maximums will fall precipitously, pushing low-income families straight off the cliff. (Mind you, this is not those on Medicaid or Medicare. This is those who buy their own plans through state portals or who are on something akin to New York’s Essential Plan.)
It’s no fun wading through all these gloomy facts and figures and trying to determine what your own family will face. Policy research from K.F.F. (formerly the Kaiser Family Foundation), puts it into the simplest terms of dollars and cents. “On average, a 60-year-old couple making $85,000 . . . would see yearly premium payments rise by over $22,600 in 2026,” K.F.F. reports. Across the country, “subsidized enrollees” can “expect their premiums to double.”
We recommend you call your insurance provider, and then call your representatives in Congress.