In the chilly early days of November 2025, a palpable sense of anxiety swept through North Conway, New Hampshire, as seniors gathered at the Gibson Center for Senior Services. More than 60 residents, many of them longtime Medicare Advantage enrollees, came together to voice fears about sudden changes to their health insurance options. The culprit? Major carriers like Aetna and Humana had abruptly pulled out of the local market just before open enrollment, leaving many Carroll County seniors with only a single Medicare Advantage plan to choose from.
This local crisis is a microcosm of a much broader national concern. Across the United States, millions of Americans who rely on the Affordable Care Act (ACA) for their health insurance are bracing for a potential spike in costs. According to an analysis by KFF, a health policy nonprofit, as many as 22 million Americans currently benefiting from ACA tax credits could see their monthly premiums more than double next year. If Congress fails to extend the COVID-19 pandemic-era subsidies, consumers will pay an average of $1,016 more in 2026, a change that could hit those on fixed incomes the hardest.
At the North Conway forum, New Hampshire Insurance Commissioner D.J. Bettencourt tried to offer some guidance. "When you're working with ... an agent or a broker who are going to sit down with you and get to understand you as a person, what your needs are, what your background is, your history, and then get to work trying to find the best arrangement possible for you," Bettencourt advised, as reported by New Hampshire Public Radio. He encouraged seniors to consider pairing traditional Medicare Parts A and B with a supplemental plan if they could afford it, and he warned about scammers preying on those desperate for answers. For those seeking help, he pointed to the state insurance department and the dedicated hotline at (603) 271-2261.
Bettencourt also stressed the importance of acting quickly. Seniors who lost their Medicare Advantage or Part D drug plans have until December 31, 2025, to enroll in new coverage, while the regular open enrollment deadline is December 7. "We can hand you off to someone who can deal with your particular challenge in the event that we cannot," he said. "So use us. Use the agents, use the brokers. We're here to do our very, very best to help you through this difficult time."
But outside the forum, the mood was far from reassuring. Protestors from the Mount Washington Valley Resistance, a local activist group, gathered to demand answers about looming rate hikes and to urge Bettencourt to press congressional leaders for an extension of enhanced ACA premium tax credits. Siena Kaplan-Thompson, one of the protestors, explained the impact on her own family: premiums could jump from $116 a month to $350. "Housing costs are going way up, food prices are still elevated," she told NHPR. "It's just a cruel moment to cut the assistance that people are relying on for health insurance."
Bettencourt, for his part, made his stance clear. "I've talked to the federal delegation very clearly about that," he said, referring to the need for continued tax credits. "I've said unless you're going to bring additional reforms forward to the ACA to help on the premium side of things, those tax credits ought to be extended." Still, for many, his assurances rang hollow. Kaplan-Thompson expressed disappointment that New Hampshire's U.S. Senators had agreed to reopen the federal government without securing an extension of the ACA subsidies.
This local drama is unfolding against the backdrop of a national debate. Earlier this month, Congress reached a bipartisan deal to end a monthlong government shutdown, but the agreement punted the decision on ACA affordability to December. The fate of pandemic-era tax credits—crucial for keeping ACA plans affordable—remains uncertain. If these credits expire at the end of 2025, millions will face sharply higher expenses.
"Unfortunately, this deal is going to prolong uncertainty for millions of Americans who get their insurance through Affordable Care Act," Sabrina Corlette, co-director of Georgetown University's Center on Health Insurance Reforms, told USA Today. "Congress is almost guaranteeing that the marketplaces will lose enrollment of people that you want to keep—the young and healthy folks."
Why is this happening? When the ACA was first signed into law in 2010, cost-saving tax credits were limited to those earning up to four times the federal poverty level. During the COVID-19 pandemic, Congress temporarily expanded these subsidies to ensure more Americans could afford coverage. Now, with those pandemic-era provisions set to expire, those earning more than $62,600 for an individual or $128,600 for a family of four will have to pay the full cost of their ACA plans. Lower-income Americans will still qualify for some help, but the extra pandemic subsidies that sharply reduced out-of-pocket costs will vanish.
Adding to the pressure, insurers are raising rates. KFF found that insurance companies selling ACA plans are increasing rates by an average of 26% for 2026. This is due to rising medical costs and greater use of health services. Without the pandemic-era subsidies, the real pain will be felt in consumers' wallets. Many may be forced to switch to cheaper plans with higher deductibles—trading lower monthly premiums for the risk of steep out-of-pocket costs if they get sick.
The Congressional Budget Office estimates the fallout could be severe: as many as 4.2 million Americans might drop their ACA coverage if the pandemic subsidies are not renewed. Conversely, extending the credits could add 3.4 million enrollees annually through 2034. The stakes are particularly high for small business owners, farmers, and gig economy workers who lack employer-sponsored insurance. John Arensmeyer, founder and CEO of the nonprofit Small Business Majority, called the failure to renew the tax credits "a huge blow to the fortunes of small businesses in America."
There are broader consequences, too. Without the enhanced subsidies, the ACA marketplaces could see a shift toward a sicker, older pool of enrollees, which would likely drive premiums even higher in the years to come. "We could be in for a stretch where insurance companies have to raise their premiums again to reflect a smaller and sicker market," Corlette warned. "So 2027 premiums are likely to be even higher, and some insurance companies may decide this is not a market they want to continue being in."
Back in North Conway, the sense of uncertainty is thick in the air. Seniors, already grappling with rising housing and food costs, now face the daunting prospect of navigating a rapidly changing insurance landscape. Advocates and officials alike urge them to seek help, ask questions, and beware of scams. But as deadlines loom and Congress dithers, the message from those most affected is clear: the need for affordable, reliable health insurance has never felt more urgent.
As the debate over health care costs and subsidies continues in Washington and across the country, communities like North Conway are left to hope that their voices—and their needs—won't be lost in the shuffle.
