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Inside the Republican Vision for Health Insurance Reform

If enhanced Affordable Care Act subsidies expire, premiums for about 22 million Americans could more than double, risking coverage loss and increased financial strain.

  • On Dec. 31, enhanced Affordable Care Act premium subsidies expire, with the ACA enrollment deadline in Omaha set for December 15.
  • Created by the Biden administration in 2021, the enhanced subsidies became tied to shutdown concessions negotiated by eight Senate Democrats, while Democrats in Congress and Republican lawmakers remain divided on renewal.
  • KFF found a record 24 million enrollments this year, with more than 90% receiving premium assistance, while premiums for roughly 22 million Americans could rise over 100% if credits lapse.
  • For affected families, Virginia's marketplace could lose 106,000 users, and Aetna plans to exit, with some facing unaffordable options, as Monahan warned on Wednesday.
  • Policy options include Republican proposals to send assistance directly to consumers and moderate Republicans seeking a temporary extension, with Congress facing a filibuster hurdle, costing about $26 billion.
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ramaonhealthcare.com broke the news in on Wednesday, November 19, 2025.
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