As the dust settles from the recent government shutdown, Americans from coast to coast are grappling with a new reality: health insurance premiums are set to soar in 2026, hitting working families especially hard. The cause, according to a flurry of reports and advocacy groups, lies in the controversial Republican-backed "Big Beautiful Bill" (H.R.1) and related policy moves that have reshaped the nation’s health care landscape—often with painful results for millions.
On October 1, 2025, health insurance marketplaces in Virginia, Idaho, and Georgia opened their online shopping tools for the upcoming year. What greeted users was nothing short of shocking. According to Protect Our Care, families could see their monthly premiums more than triple—or even quadruple—compared to 2025. For a 60-year-old couple earning $85,000 in Virginia Beach, the sticker price for a health plan will jump by $1,295 per month in 2026. In Boise, Idaho, that same couple faces a $1,472 monthly hike. And in Fulton County, Georgia, the increase is a staggering $2,064 per month—nearly four times the previous rate.
Leslie Dach, Chair of Protect Our Care, minced no words in her response: "These numbers don’t lie, but the GOP does. Donald Trump and congressional Republicans can finger-point all they want, but they’re the ones jamming millions of hard-working Americans with the largest premium increases in history while giving colossal tax breaks to billionaires. If the GOP doesn’t grow a spine and fix the health care crisis they created, the impact will be measured not only in crushing financial pain for American families, but in the loss of lifesaving health care for our friends and loved ones."
But what exactly is driving these jaw-dropping premium hikes? The answer, as detailed by KFF and Protect Our Care, is a complex mix of legislative changes, political brinkmanship, and long-standing eligibility rules that have left some of the nation’s most vulnerable populations in limbo.
First, it’s important to clarify a widespread misconception: the Republican "Big Beautiful Bill"—H.R.1—did not, in fact, open the door for undocumented immigrants to receive federally funded health care. As KFF explained on October 2, 2025, longstanding federal policy already bars undocumented immigrants from accessing Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, and subsidized Affordable Care Act (ACA) Marketplace coverage. The new law didn’t change that, and neither would overturning its health care provisions.
Instead, H.R.1 tightened the rules for lawfully present immigrants. Previously, groups such as refugees, asylees, survivors of trafficking and abuse, and certain visa holders could qualify for federally funded health programs if they met other requirements. Now, eligibility is narrowed further—to lawful permanent residents (so-called "green card" holders), Cuban or Haitian entrants, and citizens of the Compact of Free Association (COFA) residing in the U.S. Many who once relied on these safety nets have been left out in the cold.
States, for their part, have some leeway. Some use their own funds to provide health coverage to undocumented immigrants, but an earlier Republican proposal to penalize these states by slashing federal Medicaid funding was ultimately dropped from the final bill. Additionally, some states have adopted the "From-Conception to End of Pregnancy" option, ensuring coverage for low-income citizen children regardless of their parents’ immigration status. This, too, remains untouched by H.R.1.
So, if the law didn’t expand coverage to undocumented immigrants, what did it do? The most immediate effect has been to strip health coverage from several groups of lawfully present immigrants—refugees, asylees, and survivors of trafficking among them. Meanwhile, the broader Republican agenda, according to Protect Our Care and echoed by many Democratic lawmakers, has focused on cutting health care spending to fund tax breaks for the wealthy. The result: the evaporation of key tax credits that once made health insurance affordable for millions of working Americans.
The timing couldn’t be worse. With insurance marketplaces now open for window shopping, families can see in real time just how much more they’ll be paying in 2026 if nothing changes. The numbers speak volumes: a couple in Virginia Beach, Boise, or Fulton County will need to find an extra $15,000 to $25,000 a year just to maintain the same coverage they had before. For many, that’s simply not possible.
But the pain isn’t limited to premiums. The Republican law also tinkered with how emergency health care is funded for undocumented immigrants. Under the Emergency Medical Treatment & Labor Act (EMTALA), hospitals must stabilize anyone who shows up in an emergency, regardless of immigration status. Medicaid is required to reimburse hospitals for emergency care provided to undocumented immigrants who would otherwise qualify for Medicaid, except for their status. While H.R.1 didn’t change these basic protections, it did reduce the federal government’s share of the cost for such care in states that expanded Medicaid under the ACA. If the law were repealed, the federal government would pick up more of the tab, but eligibility for care would remain unchanged.
The political blame game, meanwhile, is in full swing. Republican leaders argue that their policies are about fiscal responsibility and preventing abuse of public benefits. They insist that the law targets only those who are in the U.S. unlawfully, and that any hardship faced by lawfully present immigrants or citizens is an unfortunate side effect of necessary belt-tightening. Democrats and health care advocates, on the other hand, see a deliberate attack on the working class and vulnerable communities, all to finance tax breaks for the rich.
Voters, for their part, are left with little doubt about who’s feeling the brunt of these changes. As Protect Our Care put it, "Voters don’t have to guess how much the GOP’s health care chaos is costing them." The evidence is right there in the window shopping tools: higher premiums, fewer options, and an ever-growing divide between those who can afford care and those who can’t.
It’s a debate that shows no sign of cooling off. With the 2026 election season already taking shape, both sides are sharpening their talking points. Republicans tout fiscal discipline and border security, while Democrats promise to restore lost benefits and protect the gains of the Affordable Care Act. For the millions caught in the middle, though, the reality is far less abstract—and far more urgent.
As the country stares down another year of health care uncertainty, families in Virginia, Idaho, Georgia, and beyond are bracing for tough choices and tighter budgets. The numbers may not lie, but the human cost behind them is only beginning to be understood.
