Unable to get health insurance through his job as a pastor, Saylor was able to turn to the Affordable Care Act’s Marketplace. He purchased coverage in February 2022 through a special circumstances option in the Marketplace given the quick loss of coverage from his wife’s previous coverage.
“Initially, it was awfully confusing,” Saylor said.
Upon matching his family’s needs with the right plan, Saylor was paying about $275 a month for coverage.
With the Marketplace’s enhanced premium tax credits — the government subsidies set to expire at the end of this month — his monthly premium was cut in half.
“When the tax credits were established, that drove my premium down to $134.72 a month, which was a tremendous relief,” Saylor said.
As lawmakers debate whether or not to extend the COVID-era enhanced premium tax credits for the Affordable Care Act’s Marketplace, local residents who get their health insurance through the Marketplace are preparing to pay double of what they had been paying for insurance, or even forgoing it altogether.
What are the Affordable Care Act’s premium tax credits?
The premium tax credits for the Affordable Care Act’s Marketplace health insurance plans are refundable credits that help eligible individuals and families cover the premiums for their health insurance purchased through the Marketplace, according to the IRS.
You have to meet certain requirements, and the Marketplace also determines if people are eligible for advance credit payments, which are amounts paid to people’s insurance companies on their behalf to lower the out-of-pocket cost for Marketplace health insurance premiums.
Congress authorized temporary enhancements to the tax credits through the American Rescue Plan Act of 2020 to make more low-income and middle-class Americans eligible for those tax credits, and then lawmakers extended the enhanced premium tax credits in 2022 through the Inflation Reduction Act.
The enhanced premium tax credits reduced the average Marketplace enrollee’s premium by 44%, according to the Center on Budget and Policy Priorities, a research and policy institute. This increased enrollment in Marketplace plans from 11.4 million in 2020 to 24.3 million in 2025, according to KFF, a nonprofit health policy organization.
The enhanced premium tax credits temporarily expanded eligibility for the premium tax credit by eliminating the rule that a taxpayer with a household income above 400% of the federal poverty line cannot qualify for a premium tax credit.
“Without congressional action, premium tax credit enhancements will expire at the end of this year, the premiums everyday people have to pay for 2026 marketplace plans will rise for nearly all marketplace enrollees, and 4 million people, including many self-employed workers and small business owners, will lose coverage,” Sharon Parrott, president of the Center on Budget and Policy Priorities, said in a statement.
Those against extending the enhanced premium tax credits say the subsidies were only supposed to temporary help during the COVID-19 pandemic.
“We think the subsidies should expire because they’re costly, inflationary, fraud-ridden, and because the rationale for them — the pandemic — is passed," said Health Policy Senior Fellow Dean Clancy at Americans for Prosperity, an advocacy organization.
Extending the enhanced premium tax credits would cost about $350 billion from 2026 to 2035, according to the Congressional Budget Office, which also said it would increase the number of people with health insurance by 3.8 million in 2035.
The cost of gross premiums for benchmark plans would be 7.6% lower, on average, year over year from 2026 to 2035, the Congressional Budget Office estimates.
Local residents seeing large increases heading into 2026
In 2026, nearly 60% of eligible re-enrollees will have access to a plan $50 per month for the lowest cost plan after traditional tax credits, according to the Centers for Medicare and Medicaid. This compares to 83% of eligible enrollees in 2025 and 56% in 2020 with equivalent access.
Those who qualify for traditional tax credits include households below 400% of the federal poverty level. This varies by household size, but for 2025, it was about $62,600 for one person, $84,600 for two, $106,600 for three and $128,600 for four, according to the U.S. Department of Health and Human Services.
If Congress doesn’t pass a deal to extend the enhanced premium tax credits, Marketplace premiums on average could more than double, according to a KFF analysis.
One local resident is seeing her premium go up by more than nine times what she paid this year.
Lori Kalbfleisch, of Franklin, worked in the health care industry for 30 years before retiring to help take care of her grandson. She was still on her husband’s insurance after retiring, but when he got sick and had to quit work, Kalbfleisch turned to the Marketplace for insurance.
For the first year, Kalbfleisch paid about $75 a month for insurance through the Marketplace, and it went down in 2025 to about $26 a month after her husband died.
For 2026, her health insurance is going to go to $254 a month, Kalbfleisch said.
Kalbfleisch thought about going without health insurance, but she worried that if she did that, she might experience an accident or costly medical emergency, she said. She still has a couple years before she is eligible to go on Medicare.
“I’ll just have to take it out of savings because I only get so much in Social Security a month,” Kalbfleisch said. “Every month I will have to pull from savings to make that payment.”
Small businesses seeing steep hikes
Small business owners that relied on the Marketplace for their employees and themselves are also left with rising premiums.
“Every single one of us either increased our deductible or downgraded our coverage to a bronze plan or people dropped it all together because they can’t afford a monthly premium,” said Emily Mendenhall, owner of Lily’s Dayton.
The cost varied person-to-person, but one of her employees saw their plan increase from $110 to $200, she said. For Emily Mendenhall, she said the plan she had this year with a premium of $504 a month increased to more than $800 next year, so she dropped to a lower coverage plan.
“It’ll cost me less, but I’m getting substantially lesser care with a higher deductible,” Emily Mendenhall said.
Previously they had offered employer-sponsored health insurance where Lily’s and Blind Bob’s — which is owned by Nate Mendenhall, Emily Mendenhall’s brother — paid 55% of employees’ premiums and employees paid 45%.
The group rates they were getting, though, weren’t affordable and they found they were able to get more affordable plans with comparable care through the Marketplace, Emily Mendenhall said.
“Asking small businesses to administer health care programs is not the answer either,” Emily Mendenhall said.
For Nate Mendenhall, his health insurance premium is his second biggest bill each month after his mortgage payment, he said.
He also signed up for a lower coverage plan for 2026, but he is still paying $440 a month with an $8,300 deductible and $10,000 out-of-pocket maximum.
“Why did my Anthem plan go up 25%, well beyond inflation?” Nate Mendenhall said.
‘Left floundering’
Local community members like Saylor worry about how this will affect others who maybe don’t know how to navigate the health care system.
“It feels as though those who may not have the support that I do are going to be left floundering and struggling, and all because of a narrative that isn’t accurate,” Saylor said.
He doesn’t fit the mold, he said, about broad assumptions or stereotypes about who is using the Marketplace, referencing the idea that some may have that it’s “people who just need to try harder.”
“I can say certainty I’m not alone in this. There have been more than a few other clergy members I’ve spoken to who are going through similar situations,” Saylor said.
One of Saylor’s family members, who is older, is also seeing their premiums more than double, going from $500 a month to $1,300 a month.
“It breaks my heart,” he said.
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