The 59-year-old from Edwardsville, Kansas, is one of millions of Americans who buy health insurance through the Affordable Care Act marketplace, and who could see the cost of her premium skyrocket next year unless Congress extends COVID-19-era ACA tax credits.
Democratic lawmakers had been pushing to include an extension of the Obamacare subsidies in a spending package to reopen the government. But eight Senate Democrats relented on those demands and voted with Republicans Nov. 10 to end the record-breaking 43-day government shutdown. Shortly after, the compromise passed in the House, and President Donald Trump signed it into law, without the health care measure.
“If we couldn't get it done during the shutdown standoff, it's hard to see what we shift now,” said Rebecca Kirch, executive vice president of policy and programs at the National Patient Advocate Foundation.
For Wheeler, a metastatic breast cancer patient, Congress’s ultimate decision will mean the difference of tens of thousands of dollars. Without the subsidies, her insurance will jump from $272 a month to $2,335 a month, roughly 60% of her family’s income, she said. She is currently unemployed because of her treatment and relies on her husband's income.
She can't afford to lose coverage. One of her chemotherapy drugs costs $20,000 a month, and Wheeler typically hits her out-of-pocket maximum by the end of January each year.
At first, Wheeler said she resented Democrats for negotiating a deal to end the shutdown that didn’t include the ACA measure.
“I really wish the Democrats would have held out,” Wheeler said of the shutdown. “We'll have to wait and see how this all plays out but I still feel like our feet are getting dangled over the fire.”
Ultimately, she said, she holds Republicans responsible for not dealing with the issue in the spending package they passed in July.
“We are real people with real lives and real families,” Wheeler added. “Our mortgage is also going up because of property taxes. Our utilities are going to be going up. Groceries have gone up. Everything across the board, the cost of living has gone up. I don't know what we're going to do.”
Obamacare marketplace users in limbo
Congress initially created the enhanced tax credits in 2021 to ensure Americans could afford health coverage amid the COVID-19 pandemic.
The plan expanded the pool of people eligible to buy ACA plans to those making up to four times the federal poverty level, which is about $63,000 for a single earner today, according to an analysis by the health policy organization KFF. It also decreased the percentage of income a subsidized enrollee needed to pay for coverage.
In the past five years, the enhanced subsidies have more than doubled the number of people enrolled in ACA plans, with a majority coming from red states such as North Carolina, Florida, Georgia and Texas, according to KFF.
The organization estimates that as many as 22 million Americans on ACA plans could see their monthly health insurance premiums jump 114% if the tax credits lapse, and many could lose coverage.
The Congressional Budget Office estimated that about 4 million people would go uninsured without an extension to the ACA tax credits. If passed, the subsidies would increase the federal deficit by about $350 billion by 2035, the office found.
Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, says the soaring prices are caused by a few different factors. Without the expanded subsidies, people will need to pay a larger percentage of their health insurance costs.
At the same time, insurance companies in the ACA marketplace are increasing the price of premiums because they are expecting more people to drop insurance coverage as a result of sticker shock from the ACA cuts. Fewer people, particularly fewer healthy people, paying into the system means the expenses are spread over a smaller pool, raising rates.
The Congressional Budget Office estimated that about 4 million people would go uninsured without an extension to the ACA tax credits. If passed, the subsidies would increase the federal deficit by about $350 billion by 2035, the office found.
“That's why they’re implementing gross premiums that are on average 20% to 30% higher than they would be otherwise,” Corlette said. “This is a serious financial hit to millions and millions of American families.”
Others, including Robert Kaestner, a research professor at the University of Chicago’s Harris School of Public Policy, say that the partisan debate around the enhanced tax credits has led to exaggerated claims.
Kaestner thinks the estimates of 4 million or more Americans losing health insurance are overstated. He places the number at about 2 million people, which is still a serious cost, he said, and said there are drawbacks no matter what happens.
Ending the expanded subsidies will lead people to go without health insurance, he said, but Kaestner also argued that government expenditure would be more targeted toward the poorest Americans.
"From 2020 until today, there's 20 million more people on Medicaid and in the ACA marketplaces, meaning 20 million more people getting government subsidies for their health insurance," Kaestner said. "If we look at what happened to the uninsured rate, there's no evidence that 20 million came from the ranks of the uninsured. So while I can't be sure about this, many of that 20 million came from private insurance."
Who is impacted by the loss of subsidies?
Of the 24.3 million Americans insured through ACA plans, about 92%, or about 22 million, receive some form of subsidy.
Small business owners and people who work for small businesses that don’t provide employer-sponsored health insurance make up a large chunk of people on the ACA marketplace, according to KFF.
Those include farmers, real estate agents, restaurant workers, retail workers and those working gig jobs, among others, said Anthony Wright, executive director of Families USA, a health care advocacy group.
Now that the ACA extension is no longer tied to the shutdown fight, Wright said it is “harder to see” a path where it passes Congress before the higher premiums go into effect. Open enrollment began Nov. 1 and people logging onto the ACA marketplace are already being met with higher prices.
Wright fell short of criticizing Democrats for abandoning their ACA demands in the shutdown fight, and instead blamed Republicans for not including the measure in the One Big Beautiful Bill Act.
“There's no doubt that this was a setback,” Wright said. “This should be the easiest vote in the world to prevent a huge premium spike after an election on affordability.”
But some voters who rely on the tax credits say they are frustrated with Democrats. A CBS News poll published Nov. 16 found 55% of Americans believed Republicans got more of what they wanted out of the shutdown negotiations. A majority of Democrats said their party gave in too much.
Eric Kurland, 61, and his wife, Kari Kurland, 63, purchased ACA coverage after 2021, when subsidies made the insurance more affordable. Now retired, they taught for years in Scottsdale, Arizona.
In 2025, they paid $513 per month for their ACA insurance. For 2026, Eric Kurland said the cheapest available plan in the same tier of coverage will cost $2,218.69 per month, a little over $26,000 for the year. Their combined income is about $80,000 per year, he said.
Without the subsidies, Kurland said they’re opting not to purchase ACA coverage, though they do have another option — buying health insurance through the state retirement system. Kurland estimates it will cost about $1,000 per month, about 8% of their yearly income.
"It is somewhat of a solution, which will cause us to cut back a little bit," Kurland said. "I feel the Democrats have given up the fight and I think they need to fight and I am upset with them.”
An uncertain path forward for the tax credits
Trump told congressional Republicans in a Truth Social post Nov. 18 not to “waste” their time working out an extension for the enhanced ACA tax credits. The president said he would only approve a measure that would send money “directly back to the people,” but it is unclear how such a plan would work.
Sen. Bill Cassidy, R-La., has floated a proposal in line with Trump’s favored approach that would replace ACA premium tax credits with pre-paid health savings accounts, funded partially with money from lapsed tax credits. People who sign up for a Bronze Plan, one of the tiers of coverage in the marketplace with lower premiums and higher deductibles, would be given money in an HSA account.
Cassidy, a doctor, suggested during a Nov. 16 interview on CBS News that Republicans would craft the details of the plan and put it up for a vote against Democrats’ proposal to extend the ACA enhanced subsidies by mid-December.
But the two parties so far remain in a stalemate, and Congress has only three working weeks left on its schedule for the year.
As the clock ticks, Wright at Families USA said some are already beginning to make final health care decisions for next year. The ACA open enrollment period runs from Nov. 1 through Jan. 15.
“Every day we delay, these higher rates get baked in and more people look at these skyrocketing premiums and get sticker shock and just plan to fall off coverage,” Wright said. “Every day we delay causes further damage to both individual families and to our system.”
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