The website of Connect for Health Colorado, the state's health insurance marketplace, is pictured on Aug. 27, 2025. (Photo by Chase Woodruff/Colorado Newsline)

WASHINGTON — Americans who purchase their health insurance through the Affordable Care Act marketplace are bracing for a steep rise in costs next year that many say they will not be able to afford, according to a poll released Thursday by the nonpartisan health organization KFF.

Nearly 60% of enrollees surveyed could not cover the costs of a $300 annual increase in their premiums, while an additional 20% said they couldn’t afford a $1,000 jump in prices per year. 

About 90% of those polled said it would be somewhat or very difficult to afford health insurance within their budget if they could no longer purchase a plan through the ACA marketplace.

The spike in prices is predominantly due to the end-of-year expiration date for enhanced tax credits for ACA marketplace plans. Republicans in Congress have so far declined to extend the subsidies, while Democrats shut down the government in an unsuccessful attempt to continue the credits.

While increases would vary considerably based on location, income and plan type, a Sept. 30 KFF analysis projected individuals’ annual premiums would rise between around $350 and more than $1,800.

Open enrollment for ACA marketplace plans ends at different times throughout the country, with some states finishing on Dec. 15. Residents of other states are able to sign up through varying dates in January, but with their coverage starting later in the year. That doesn’t give Congress much time to broker a deal before the ability to purchase a plan for next year closes.

No progress on negotiations

The Senate is expected to vote next week on a Democratic bill to extend the subsidies, though that legislation appears unlikely to get the 60 votes needed to advance in the Republican-controlled chamber. 

The Health, Education, Labor and Pensions Committee held a hearing this week to explore short- and long-term options to bring down health care costs, but senators on that panel didn’t reach a clear consensus. 

KFF President and CEO Drew Altman said in a statement the “poll shows the range of problems Marketplace enrollees will face if the enhanced tax credits are not extended in some form, and those problems will be the poster child of the struggles Americans are having with health care costs in the midterms if Republicans and Democrats cannot resolve their differences.”

The KFF poll showed only 9% of marketplace enrollees have a lot of confidence that Republicans in Congress will address rising health insurance costs, with 24% saying they had some confidence, 25% saying they didn’t have much confidence and 42% responding they had no confidence in GOP lawmakers on that particular issue.

Blame falls to Trump

ACA marketplace enrollees would predominantly fault President Donald Trump if their overall health care costs, including premiums, co-pays and deductibles, were to increase by $1,000 next year, though Republicans and Democrats in Congress would share nearly as much blame, the survey found.

Thirty-seven percent would place the responsibility with Trump, while 33% would cite GOP lawmakers and 29% would fault Democrats with the rising costs.

Those numbers fluctuate significantly depending on a person’s political affiliation, with 65% of Republicans saying they would blame Democrats, while 20% would credit Republicans in Congress and 14% would fault Trump.

Forty-four percent of people who identified as independents said they would blame Trump, while 32% said they would cite Republicans in Congress and 23% said they would fault Democrats.

Among Democrats, 49% would blame Trump, 46% would credit congressional Republicans, with the remainder would fault members of their own party.

KFF conducted the survey of 1,350 people between Nov. 7-15. It has a margin of error of plus or minus 3 percentage points for the full sample, with a plus or minus 6 percentage points margin of error for political party affiliation questions.

Senate Majority Leader John Thune, R-S.D., speaks to reporters while walking to his office on Nov. 10, 2025 on Capitol Hill in Washington, D.C. (Photo by Tom Brenner/Getty Images)

WASHINGTON — Republicans and Democrats in the Senate agree that health care costs are rising too quickly and expect to vote next week on legislation that could help Americans. 

The only catch is that party leaders hadn’t decided as of Tuesday what to include in the bills. 

Senators also seemed to accept that neither proposal will garner the bipartisan support needed to advance, leaving the tens of millions of Americans who purchase their health insurance from the Affordable Care Act marketplace with complicated decisions to make before open enrollment in some states ends as soon as Dec. 15. 

ACA marketplace plans are expected to increase by 26% on average next year, though a failure by Congress to extend enhanced tax credits would lead monthly payments for subsidized enrollees to increase by 114% on average, according to analysis from the nonpartisan health organization KFF. 

“I don’t think at this point we have a clear path forward,” Senate Majority Leader John Thune said. “I don’t think the Democrats have a clear path forward.”

Vote on Democratic bill expected

Thune guaranteed a small group of Democratic senators a floor vote on a health care proposal of their choosing in exchange for their votes on the spending package that ended the government shutdown. 

Democrats are widely expected to put forward a bill to extend enhanced tax credits for people who buy their health insurance from the Affordable Care Act Marketplace. Those subsidies are set to expire at the end of the year without congressional action. 

But it isn’t clear if the Democratic bill would extend the credits for one year or a longer period. 

GOP leaders are trying to rally support around a health care proposal of their own, while acknowledging it won’t get the 60 votes needed to advance under the Senate’s legislative filibuster rules. 

Thune said Republican senators had a “robust discussion” about health care issues during their closed-door lunch, where Finance Committee Chairman Mike Crapo of Idaho and Health, Education, Labor and Pensions Committee Chairman Bill Cassidy of Louisiana presented some ideas. But no final agreements were reached. 

Thune, R-S.D., said conversations will continue ahead of the vote next week and likely afterward.

Senate Minority Leader Chuck Schumer of New York said Democrats “have a plan” but declined to say exactly what it entails.

“Stay tuned,” Schumer said. “We had a great discussion and I will tell you this: We will be focused like a laser on lowering people’s costs.”

Looking for a solution

West Virginia Sen. Shelley Moore Capito said Republican talks on health care have been “vigorous” but that they hadn’t yet “decided on the clear path.” 

Capito said her “expectation” is that GOP senators will put a bill on the floor next week to bring down the costs of health insurance premiums and health care as quickly as possible, though that hadn’t been finalized.  

“I like the idea of people having control of the money as opposed to insurance companies, where they take a 20% profit,” Capito said, echoing comments by President Donald Trump. “I think that has merit.”

Capito said senators didn’t discuss during their lunch whether to extend open enrollment or possibly reopen it next year, should Congress pass a health care bill that addresses the ACA marketplace tax credits in some way.

New Hampshire Democratic Sen. Jeanne Shaheen said there is no indication there will be bipartisan agreement to extend the enhanced ACA subsidies or any other health care proposal by next week’s vote, though bipartisan conversations continue.  

As for Democrats’ plan, Shaheen said it wasn’t “clear” what legislation party leaders will put on the floor for a vote or when they’d make that announcement. 

‘Mindful of the timeline’

North Dakota Republican Sen. John Hoeven said there is “strong support” among GOP lawmakers for making changes to how the enhanced ACA tax credits work before extending them for any length of time. 

But he said those negotiations will take more time. 

“In my opinion, if we have (the vote) next week, we probably won’t be at a point where we can get a big bipartisan agreement,” Hoeven said. “It’s more likely they’ll put something up that fails. We put something up that fails. And we keep working towards, hopefully, something that can work and that is bipartisan.”

There is a “good chance,” he said, that will happen in December or January, a timeline that would likely put a solution after open enrollment closes. 

Hoeven declined to say if a deal would extend open enrollment or include a second window for Americans to select insurance, but said Republicans are aware of the deadlines. 

“We’re very mindful of the timeline,” Hoeven said. “So all the things we’re talking about recognize that it needs to be able to take effect next year or this year.”

Boxes of the diabetes drug Ozempic rest on a pharmacy counter in Los Angeles. Drugs like Ozempic have grown in popularity to treat obesity, prompting more than a dozen states to pay for them. But with major budget pressures, several state Medicaid agencies are either stopping coverage altogether or restricting who can get access to the therapy. (Photo illustration by Mario Tama/Getty Images)

Some states are rethinking their coverage of GLP-1 drugs for weight loss as budgets tighten and Medicaid programs brace for the cuts included in President Donald Trump’s broad tax and spending law.

As of Oct. 1, 16 state Medicaid programs covered GLP-1s for obesity treatment, up from 13 last year, according to a survey of Medicaid directors by KFF, a health policy research group. But some states have announced they will discontinue coverage or restrict who can qualify for it.

Many doctors and patient advocates say the drugs will save money in the long run by reducing obesity-related diseases such as heart disease and diabetes. Many states, however, have concluded they just can’t afford them.

North Carolina Medicaid ended coverage of GLP-1s for obesity last month, citing shortfalls in state funding. California, New Hampshire and South Carolina have said they will end coverage on Jan. 1. Starting next year, Michigan Medicaid will limit coverage to people who are “morbidly obese.” Pennsylvania, Rhode Island and Wisconsin also are considering new restrictions.

In last year’s KFF survey, about half the states said they were interested in covering GLP-1s for weight loss, according to Elizabeth Williams, a senior policy manager at KFF who focuses on Medicaid. This year, most states are moving in the opposite direction.

“This likely reflects recent state budget challenges and the significant, significant costs associated with coverage,” Williams said. “After a number of years of robust revenue growth right after the pandemic, states are starting to see slowing revenues, increasing spending demands and a lot of fiscal uncertainty due in part to recent federal actions.”

In April, the Trump administration scrapped a Biden-era proposal that would have required state Medicaid programs to pay for some GLP-1s for obesity treatment. Earlier this month, Trump announced that his administration had reached agreements with the manufacturers of Wegovy and Zepbound to reduce the prices of the drugs for Medicaid, Medicare and consumers buying the drugs directly, But it’s unclear whether the deals will reduce costs for states.

Health plans for state workers also are reassessing their coverage of the drugs for obesity. North Carolina, for example, ended GLP-1 obesity coverage for state workers last year, and West Virginia canceled a 1,000-person pilot program.

GLP-1 medications, which balance blood sugar levels, have long been prescribed to patients with Type 2 diabetes and cardiovascular conditions. All state Medicaid programs, which are funded jointly by the states and the federal government, cover GLP-1s for those uses.

But the drugs also curb hunger signals and can help people lose significant amounts of weight. Medications such as Ozempic, Wegovy and Zepbound have become wildly popular for that purpose.

Between 2019 and 2023, the number of outpatient Medicaid prescriptions for select GLP-1s to treat diabetes and obesity grew from 755,300 to 3.8 million, according to KFF. During the same period, Medicaid spending on those drugs increased from $597.3 million to $3.9 billion.

A study published last year in The BMJ, the journal of the British Medical Association, found that the number of patients without diabetes who started GLP-1 treatment in the United States increased from roughly 21,000 in 2019 to 174,000 in 2023, or more than 700%.

More than 2 in 5 U.S. adults have obesity, according to the federal Centers for Disease Control and Prevention. The CDC defines obesity as having a body mass index — a calculated measure of body weight relative to height — of 30 or higher. Obesity costs the U.S. health care system almost $173 billion per year, according to the agency.

Recently, the manufacturers of some GLP-1s have lowered their prices, selling them directly to consumers for $500 or less per month. But many patients cannot afford to pay that much out of pocket.

States in a tough financial position

In North Carolina, Dr. Jennifer McCauley, a weight management physician at UNC Health, said Medicaid coverage of GLP-1s was “incredibly helpful for our patients.”

“Now they’ve stopped coverage, so those people are now going back, regaining some of the weight, because they’re unable to obtain these medications, and also are suffering the health consequences of obesity,” McCauley told Stateline.

Some critics of expansive GLP-1 coverage say it isn’t cost effective, because many patients gain back the weight they lost when they stop treatment. But McCauley said the “downstream effects of obesity are even higher.”

“There are definitely vulnerable populations that probably would not be able to obtain weight loss without these medications.”

James Werner, a spokesperson at the North Carolina Department of Health and Human Services, blamed the coverage change on the state legislature’s failure to budget enough money for Medicaid.

In an email to Stateline, Werner said coverage of GLP1s for weight loss “would be reconsidered if Medicaid is fully funded.”

Some states are trying to maintain at least some coverage of the expensive drugs by tightening the eligibility requirements for a prescription, according to Colleen Becker, a project manager at the National Conference of State Legislatures, a policy research group.

“States are really looking at how to balance access and provide that access to patients, but they’re stewards of their budgets, and they need to be good stewards of it,” Becker said.

Michigan and Pennsylvania are among the states considering such options. Meanwhile, Connecticut has decided to maintain coverage of weight-loss drugs for state employees, but to require beneficiaries to try online weight-loss counseling before they can get a prescription.

Some future possibilities

One state, North Dakota, has taken a different approach to GLP-1 coverage after legislation that would have required the state’s Medicaid program to cover the drug failed. Instead, North Dakota this year became the first state to mandate that insurers on the state’s Affordable Care Act marketplace cover the drugs for weight loss.

North Dakota Deputy Insurance Commissioner John Arnold said the insurance department calculated that the mandate wouldn’t cause insurance premiums to rise significantly.

“It’s not that anybody can walk into the doctor’s office and say, ‘Hey, I want to have this covered,’” Arnold said. “It is really for those who have a medical need for the drugs, then it would be covered.”

The insurance department had to ask the legislature for permission to make the change, according to North Dakota Republican House Speaker Robin Weisz. He said insurance carriers were concerned that it was going to be “open season for everybody who could lose 20 or 30 pounds.”

He said it will take time to see whether the policy raises insurance premiums.

“If the carriers can come in a couple years and say, ‘Wow, here’s what we’ve spent on these … we’ll take a hard look at it,” Weisz said. “But, it’s way too early to tell at this point.”

Arnold says other states may have the flexibility to consider mandating ACA insurers to cover the drugs.

“Our biggest concern was reducing those comorbidities and the long-term impact that that has on the cost of insurance in general, because more comorbidities means more claims,” Arnold said, referring to diseases and conditions associated with obesity.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.