LEBANON — Upper Valley residents are among the over 24 million Americans expecting to see increased health insurance costs should the enhanced subsidies of the Affordable Care Act expire at the end of the year, as planned.
A primary cause of the longest ever federal government shutdown, which ended earlier this month, the expiring subsidies will force many of the approximately 50,000 Granite Staters on plans purchased through the ACA to go uninsured, Dr. Ken Dolkart, a geriatric specialist, said at a roadside protest of federal health care cuts on Wednesday morning outside of Dartmouth Hitchcock Medical Center.
The 2010 Affordable Care Act instituted markets in individual states, through which people have been able purchase health care plans from private insurers. The law also provided federal subsidies that made plans more affordable, which were extended in 2022.
Plans purchased through the ACA were beneficial in doing away with preexisting conditions and covering preventative care such as mammograms and colonoscopies, Dolkart said. Dolkart is a member of the Physicians for National Health Program, which helped to organize the protest that included about a dozen participants, six of whom were doctors.
“Today we’re out here because (plans purchased through the ACA) are going to become unaffordable,” Dolkart said.
Jackie Atherly, a 63-year-old retired school teacher from Grantham, is among those feeling the financial pressure from the expiring tax credits.
“I feel let down,” she said at Wednesday’s protest.
Atherly, who is just two years away from qualifying for Medicare, held a sign that read “Big Bill of Betrayal,” referring to the Trump Administration’s “One Big Beautiful Bill.”
The legislation enacted in July made large cuts to federal health care spending.
Democrats forced a government shutdown in October over the subsidies, which are set to expire at the end of the year, as a key driver of health care affordability, the Associated Press reported.
Permanently expanding the enhanced tax credit structure would increase the federal deficit by $350 billion over the next 10 years, according to the Congressional Budget Office.
Atherly, who is currently on the lowest tier of plans, bronze, has been paying $469 per month in premiums, she said. Next year, she expects to pay $827 per month.
“I feel disappointed that I have to tap into my savings to pay for my health care,” she said. “It kind of seems like our federal government is taking away something that we greatly need.”
Expiring subsidies are estimated to increase premium rates by 22% in New Hampshire, according to the health care advocacy nonprofit New Futures. Nationally, premiums are estimated to rise 114%, according to the Kaiser Family Foundation, a health care research nonprofit.
Anywhere from 25% to 50% of people currently on plans purchased through the ACA won’t buy for the upcoming year because of the “sticker shock,” Lynn Guillette, who leads the contracting efforts for the health plans of Dartmouth Hitchcock and Dartmouth clinics, said in a Tuesday video interview.
Those who opt not to buy insurance will “hope to God that there’s no traumatic health issues. They don’t get in a car crash. They don’t get cancer (and) their kid doesn’t break their leg,” Guillette said.
Tough choices
Those who aren’t insured through their employer bear much of the uncertainty.
Amy Franklin, 44, organizes wreath classes and summer “dinners in the orchard” at Riverview Farm, which her parents founded.
The small Plainfield farm can’t reasonably afford to supply its employees with health insurance, Franklin said.
She has a seizure disorder that requires constant medication and a yearly neurologist visit, placing her in New Hampshire’s “high-risk pool.”
“Without health insurance, (the condition requires) for sure a cost that, you know, has an impact on my household income,” Franklin said.
After Franklin was denied health insurance in 2014, she was able to purchase a plan through the ACA — which doesn’t discriminate against preexisting conditions, like her seizure disorder.
“It was incredible because I couldn’t be denied health insurance,” she said.
She currently pays about $200 a month for a silver-tier plan with around $150 subsidized by the ACA tax credits.
While she hasn’t checked to see exactly what her premiums will be without the enhanced subsidies, Franklin is worried that she won’t be able to afford the increase. Depending on the cost, she will either have to turn to the private market or be left uninsured.
As someone in the “high-risk” pool, the private market would have “unreasonable” prices, such as the $800 monthly premium presented to her before she found her plan purchased through the marketplace created by the ACA.
‘Ripple effect’
Everyone on plans purchased through the ACA can expect their premiums to increase, but increases won’t be uniform, Guillette said. They will depend on people’s medical profiles and geographic location. Those making over 400% of the federal poverty level will lose subsidies entirely.
The subsidy change will have a “ripple effect,” impacting the insurance pool and hospitals, Population Health Officer at Dartmouth Health Sally Kraft said in a Tuesday video interview.
The additional expenses will force people to choose between expenses such as housing and health care, and many will choose to forgo health care — especially healthy people, Kraft said.
As the pool of insurance buyers becomes smaller and sicker, insurance companies may hike prices for others to make up for losses, she said.
Hospitals also face pressure from the change.
Many patients will no longer receive preventative care and will then contribute to crowding emergency departments, Kraft said. And those without health insurance will also not be able to pay some of their hospital bills, which will further strain hospitals.
Small, rural hospitals will especially bear the hurt, as they “live on the margin,” Guillette said.
Small to mid-sized businesses also face possibly unaffordable cost increases.
Businesses that reimburse their employees’ plans purchased through the ACA may no longer be able to swing the additional cost. And as smaller businesses seek to avoid this cost, employees will leave for larger companies that offer their own health insurance, Guillette said.
While coverage until the end of 2025 will remain unchanged, the open enrollment period for the 2026 calendar year began on Nov. 1 and will go until Jan. 15, 2026.
To receive coverage for the first month of 2026, however, the deadline is Dec. 15, 2025.
Kraft advises people not to wait until the final deadline of Jan. 15, due to the risk of being left uninsured.
“Don’t wait until the last minute,” Kraft said. “Go (online) and get as much information as you can.”
“Look at what prescription meds you’re taking. Look at what your usual health care needs are (and) pick a plan,” Kraft said.
“You will see an increase in the premium,” she added. “But it’s better to enroll now because we don’t know what’s going to happen by the end of the year in terms of a vote in Washington, D.C.”
Resources
New Hampshire residents can get personalized help at newhampshirenavigator.com.
Vermonters can access insurance brokers, counselors and navigation organizations through Vermont Health Connect website, info.healthconnect.vermont.gov, under the subheading “Find Local Help.”
The Kaiser Family Foundation has a calculator that can estimate 2026 premium rates without enhanced subsidies, which can be accessed at kff.org/interactive/subsidy-calculator/.
Local help can also be found through Healthcare.gov under the subheading “Find Local Help.”