LOUISVILLE, Ky. — Affordable Care Act (ACA) subsidies that helped lower insurance premiums for millions expired on New Year’s Eve, raising concerns that many Kentuckians could face steep healthcare costs or lose coverage.
At Family Health Centers in Louisville, insurance navigators say the change could push healthcare out of reach for some patients. “People are feeling the squeeze right now, and when you add increased health insurance cost to it, something’s got to break,” said Ashley Shoemaker, director of outreach and enrollment.
The debate over extending tax credits contributed to the 43-day government shutdown in 2025. Lawmakers were unable to reach an agreement before the subsidies expired, and the bipartisan bill that ended the shutdown did not include an extension.
Shoemaker, who helps patients select insurance during open enrollment, said premiums have already skyrocketed for some. “My coworker saw someone’s premium increase $700 a month,” she said, noting that average premiums are rising about $100 monthly — a 42 percent increase.
“These patients had plans in 2025, but when they shopped for coverage this year, they saw the increase and said, ‘I’ll just go without,’” Shoemaker added. So far, 61 people at the clinic have chosen to drop their insurance, while others are opting for lower-level plans with higher deductibles.
ACA tax credits primarily help individuals who are not eligible for Medicaid and do not have employer-provided insurance, such as small business owners, farmers, and trade workers.
Bart Irwin, CEO of Family Health Centers, said about 25 percent of their patients — roughly 10,000 people — are uninsured. “They won’t stop coming to the health center for care. They will come back as uninsured patients, and we will provide them service,” he said. “If we see an increase of 2,000–3,000 more uninsured patients, it’s going to stress the health system.”
There is a possibility the situation could change. The U.S. House of Representatives may vote in January on a Democrat-led bill to extend the subsidies for another three years.
“I’m hoping for a belated Christmas miracle,” Shoemaker said. “People just can’t afford these prices.”
She noted that some ACA subsidies are still available, but eligibility is now more limited. Individuals with incomes above $62,000 — over 400 percent of the federal poverty line — are no longer eligible for assistance.
The deadline to sign up for ACA insurance is January 15.
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