Robert F. Smith reports for The Commons on Bellows Falls and surrounding communities. A longtime reporter and editor in the region, he has also worked in frontline health care.
BELLOWS FALLS-The rapidly approaching end to subsidies for families using the Affordable Care Act (ACA) for health insurance has many Vermont households looking at health insurance premiums that will double, triple, or rise by even greater magnitude in 2026.
It is estimated that 42,000 Vermonters will be affected by these increases, while nationally 44 million Americans rely on the ACA for their health insurance. The impact on families and the Vermont and national health care systems - already in crisis - could be devastating.
Consumers have until Dec. 15 to sign up for 2026 health coverage through the ACA, whose premium tax credits are scheduled to end on Dec. 31. They were first enacted in 2021 during the pandemic and provided enhanced benefits and expanded eligibility for users.
Participation in the ACA marketplace nationwide more than doubled during this time, and almost 8,000 Vermonters entered the marketplace since 2021, according to KFF (formerly the Kaiser Family Foundation), a health-care-policy think tank.
In 2022, the subsidies were extended as part of the Inflation Reduction Act. However, on Jan. 1, 2026, the benefits and subsidies will revert to pre-2021 levels.
Vermont Health Connect is the state's health insurance marketplace for the ACA. More than 32,000 Vermonters use it to enroll in health insurance plans, and more than 75,000 are enrolled in the Medicaid expansion program, which is also part of the ACA.
Together, more than 107,000 Vermonters, or about 16% of the state's population, have some form of health insurance coverage through the ACA.
Vermont Health Connect is administered by the Department of Vermont Health Access (DVHA) under the oversight of the Agency of Human Services. It was created to help Vermonters who do not have health insurance through their employer, to compare and enroll in health coverage that best fits their needs and budget.
It offers both private plans, known as Qualified Health Plans, and public programs like Medicaid and Dr. Dynasaur.
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The ACA tax credits, and the U.S. health care system in general, have become highly politicized. Both parties - but especially the Republican Party - face consequences depending on how these health insurance issues are handled.
Ending the ACA, a centerpiece policy of a Democratic Party president, Barack Obama, has been a stated goal of the Republican administration of Donald Trump. As one of his first official acts after his inauguration in January, Trump rescinded the policy of his predecessor, Joe Biden, to encourage participation in and to find ways to strengthen the ADA.
In their official party platform, Republicans have promised to "increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options. We will protect Medicare, and ensure Seniors receive the care they need without being burdened by excessive costs."
But despite a decade and a half of Republican opposition to the ACA and promises to provide better and cheaper health coverage, Republicans have yet to propose any form of a health program to replace it.
When the ACA was passed in 2010, Vermont was one of the states that opted to build its own health insurance marketplace instead of joining the federal one. At the time, the Legislature believed the state would be in the best position to help Vermonters choose among what are often very limited health insurance options.
With its small and aging population, Vermont is not an appealing place for for-profit health insurance companies to offer coverage. These demographics severely limit insurance options in the state.
Health insurance coverage in Vermont comes from only two health insurers: Blue Cross Blue Shield of Vermont (the larger) and MVP Health Care.
The 2022 extended subsidies increased the eligibility to those with incomes over 400% of the federal poverty level, currently about $63,000 for an individual, and increased the subsidy amounts to lower- and middle-income individuals.
All that ends in two months. At that time eligibility will be capped back at below 400% of the federal poverty level, which is calculated by household size. For a family of four, that threshold is $128,600; for an individual, it's $62,600. Subsidies will be drastically cut.
A September analysis from the nonpartisan Congressional Budget Office estimated that permanently extending the enhanced tax credits would cost $350 billion over the next decade, while ending them would mean 4 million more Americans would be added to the uninsured.
KFF, a respected, independent organization focusing on health care issues, says its polling shows that the tax credits are highly popular, with 78% of Americans wanting them to continue - including the majority of Republicans.
The KFF poll also noted that "both parties could face political fallout if the enhanced tax credits are not extended," though it found that 80% of those polled said they would place most of the blame on the current Republican administration.
Adding to the pressure for Republicans to resolve these issues is the fact that far more people who identify as Republican use the ACA than do Democrats, and nearly 60% live in Republican-controlled states or in congressional districts represented by a Republican.
More SNAP benefits go to Republican-led states than Democratic-led states. As is the case with ACA, more states with Republican-leaning voters face the biggest negative impacts from the increasing insurance premiums and the government shutdown.
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It is projected that the average Vermont family under the ACA will see their monthly health insurance premiums more than double. The KFF poll found that 70% of Americans who buy their own health insurance said the increase would "significantly" disrupt their finances, while 40% said they would have to drop their health coverage if premiums doubled.
But many families in the program are getting proposed 2026 insurance premium figures that are much more than doubling.
Jennifer Heidbrink, director of the Parks Place Community Resource Center in Bellows Falls, recently received her new insurance premium numbers from Vermont Health Connect for 2026. They are typical of what many Vermont families are facing.
She said that her family of four had been paying about $1,100 in monthly health insurance premiums, totalling $13,200 a year.
But Heidbrink said she received notice in mid-October that because of the end of tax credits this year, her family's monthly premium will jump to $3,750, a 341% increase in her premium.
Her family's yearly insurance premium of $45,000 is well over half of the median Vermont household annual income of $81,000.
"Vermonters making $40,000 to $60,000 a year, middle- income families, can't afford this insurance," Heidbrink said.
She noted that the expiration of the subsidies could affect as many as 35,000 Vermonters, which will create a ripple effect on social service nonprofits like Parks Place.
Also, as of Jan. 1, 2026, several Medicare Advantage plans for people over age 65 will no longer be offered in Vermont and New Hampshire. The Vermont Blue Advantage Medicare Advantage plan is leaving, as are Anthem, Martin's Point, and Aetna.
That creates another looming deadline, as Medicare open enrollment ends Dec. 7, and anyone enrolled in one of the no-longer-available Advantage plans will have to choose new coverage. Those who don't will be automatically enrolled into traditional Medicare.
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Adding to the confusion is the federal government shutdown, the cutting of funding for hospitals and health centers, the layoff of thousands of federal health-care employees, and an estimated average of 18% to 26% increases in health insurance premiums in general.
It all adds up to a health care system in crisis.
Also as of Nov. 1, the government shutdown - headed to become the longest shutdown in the nation's history - means that Supplemental and Nutrition Assistance Program (SNAP) benefits will not be sent to some 42 million Americans - 1 in 8 - who depend on this assistance.
That group includes more than 66,000 Vermonters, more than 10% of the population. Of them, more than 6,000 live in Windham County.
No clear Republican health plan has been presented in either Trump term.
Nor has any plan been presented by the Republican majority to deal with the immediate problem of massive ACA premium increases and the rising health insurance premiums in general.
In an Oct. 27 press conference specifically addressing health care concerns, House Speaker Mike Johnson (R-La.) said that "the expiring Obamacare subsidy at the end of the year is a serious problem."
Johnson said House Majority Leader Steve Scalise (R-Louisiana) is working with the chairs of three House committees to compile an alternative Republican health care plan, but no specifics have emerged.
The House speaker spoke in general about broader health care reforms and the Republican Party's belief in using the private sector, the free market, and individual providers for insuring Americans, as opposed to the Democratic Party idea of universal health care. Republicans have also presented ideas like expanding health saving accounts and overhauling the pharmacy benefit manager industry.
But they have yet to present a specific plan to meet the nation's health care needs.
The lack of any kind of Republican health care alternative is attracting increasing scrutiny and criticism from its own party, notably U.S. Sen. Josh Hawley of Missouri and U.S. Rep. Marjorie Taylor Greene of Georgia.
On Oct. 28, Greene said that during a private call with other House Republicans regarding health care, she confronted them for the party's lack of plans in dealing with the ending subsidies.
"Johnson said he's got ideas and pages of policy ideas and committees of jurisdiction are working on it, but he refused to give one policy proposal to our GOP conference on our own conference call," Greene wrote after the meeting.
The ACA tax subsidies have become a major political football. Republicans have never voted for the expiring subsidies, but their leaders say that before they can talk with the Democrats about fixing health care, the Democrats will need to approve the new budget.
On the other side of the aisle, Democrats say they will not approve a new spending bill unless it agrees to an extension of the enhanced tax credits.
It is estimated that initially up to 5 million Americans are at risk of losing their health insurance as of Jan. 1 due to the massive ACA premium increases.
Other provisions of Trump's budget, such as requiring some Medicaid recipients to work a certain number of hours monthly, changing other eligibility requirements, and massive cuts to Medicaid and the ACA, are estimated to add as many as 15 million people to the uninsured rolls as the policies are implemented in the coming months.
According to KFF, similar to the demographics of SNAP benefits, nearly 6 in 10 people who have health coverage through the ACA marketplace live in congressional districts represented by a Republican.
Democrats are hoping that the shock of the massive premium increases citizens are now being notified about will move Republicans to negotiate on the proposed budget. Democrats note that the Republican attempts to repeal the ACA without any proposed replacement lost them the House in the 2018 midterm elections.
For many, these are just symptoms of what U.S. Sen. Bernie Sanders calls the "broken, dysfunctional and cruel" current U.S. health care system.
In early October, Sanders released a report, "I'm Terrified I'll Die: Americans Speak Out About Republican Health Care Cuts," in which he discusses the results of the Republican health care cuts on a system already in crisis.
He notes that Americans spend twice as much per person on health care compared to all the other industrialized nation with universal health coverage, yet Americans have a lower life expectancy and millions of uninsured citizens.
The leaders of both parties agree on one thing: the health care system in the U.S. is broken.
Speaker Johnson echoed Sanders' concerns about a "broken, dysfunctional" healthcare system when he said at the Oct. 27 press conference, "If you look at it objectively, you know that it is subsidizing bad policy. We're throwing good money at a bad, broken system, and so it needs real reforms."
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Concerned that the federal government shutdown might interrupt the income of many Vermonters for a variety of reasons, the Vermont Department of Financial Regulation (DFR) in an Oct. 24 press release advised "individuals who are having trouble managing loan, mortgage, or insurance payments to proactively communicate with their lenders or insurers."
The DFR added that "companies are equipped to work through these challenges with individuals. However, they cannot offer options or assistance if they do not know your situation."
"Do not wait for cancellation, default, late fees, or penalties to accrue," Commissioner Kaj Samsom said in the release. "If you are experiencing or anticipating financial hardship as a result of the federal government shutdown, reach out to the company to explore what flexibility and options they can offer."
Samson added that companies are being urged "to use all available options and alternatives to assist individuals who are temporarily unable to make payments or meet their obligations due to the federal government shutdown."
With the ongoing federal government shutdown preventing SNAP benefits being paid after Nov. 1, a health coverage deadline looming on Dec. 15, and ACA subsidies ending on Dec. 31, time is quickly running out to resolve what could become the worst health care situation in modern history, affecting millions.
This Voices column by Robert F. Smith was written for The Commons.
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