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After two congressional proposals to alleviate the rising costs of Affordable Care Act health insurance plans failed to pass Thursday, many Georgians could see their rates more than double for next year.
At issue are tax credits that lowered the cost of ACA plans that are set to expire Dec. 31. The credits were enacted as part of a Covid relief package in 2021. Unless Congress takes action to extend the credits, premiums for Georgians will, on average, more than double, a recent Georgia Health Initiative analysis found.
The enrollment deadline is Monday for coverage to begin Jan. 1.
The GHI analysis predicts that the higher costs would prompt about 340,000 of the 1.5 million Georgians who are enrolled in the ACA to go without insurance next year. The analysis is based on data showing how many people enrolled after the premium tax credits took effect.
Congress is set to recess for the holidays next week. On Thursday, a Democratic proposal to extend the subsidies and a Republican proposal to provide enrollees with additional funds for health care costs instead both failed on 51-48 votes in the U.S. Senate.
The exact amount of the rate increases will vary based on several factors, but on average, premiums in Georgia will more than double, from an average of $69 per month this year to $148 per month in 2026, according to the GHI report.
Many will likely “buy down” to lower-coverage plans that may have lower premiums, but higher out-of-pocket costs, the analysis said.
How will higher costs impact health care in Georgia?
People who make more than 400% of the poverty level (about $62,600 for a single person, or $128,600 for a family of four) will see the biggest increases if Congress doesn’t act, said Louise Norris, health policy analyst for Healthinsurance.org.
“All of a sudden they’re faced with full-price premiums, which are really high, depending on how old you are, and where you live,” Norris said. People making less than 400% of the federal poverty level will also see increases, she said.
Many people will opt to go without insurance, which will increase health care costs across the board, Norris said.
Employer-sponsored plans and Medicare plans have also set higher premiums for next year.
“When you increase the uninsured rate, you do drive up costs for everyone who still has insurance,” Norris said.
Anna Adams, senior vice president of government relations at the Georgia Hospital Association, said, “Hospitals will continue to provide high-quality care to all patients, regardless of their ability to pay, but the loss of coverage for many of those patients will have a substantial impact on hospitals’ ability to stretch already scarce resources.”
Many patients without insurance will turn to emergency room care, Norris said, for which they won’t be able to pay. That will cause hospitals to raise rates, which will drive up premiums for everyone.
Who is eligible for Affordable Care Act insurance and where to find plans in Ga.
U.S. citizens, nationals, or lawfully present immigrants who are not incarcerated can enroll in the plans. About 1.5 million Georgians, or around 13% of the population, currently use the plans.
Most of those enrolled do not have access to insurance through their employers.
To compare plans and enroll, visit GeorgiaAccess.gov. In the past, Georgians purchased their insurance through a federal website called the Marketplace. The state established its own portal last year.
What happens if Congress doesn’t extend the tax credits by the Monday deadline?
The rates listed on GeorgiaAccess are the rates that will take effect if Congress does not act, Norris said. She advises selecting a plan by Monday’s deadline.
“You can base your decision on those numbers. Pick a plan, but then don’t just tune out completely. Make sure you still keep an ear to whether or not anything is changing,” she said.
Congress could still renew the subsidies or agree to another plan to lower costs even after the deadline, retroactively.
What happens if you miss the Monday deadline to enroll?
Those who have health insurance through Georgia Access will be re-enrolled in the same plan or the most similar plan available for next year.
Aetna will not be offering ACA insurance in 2026, so those customers will be shifted to another company, said Bryce Rawson, a spokesperson for the Georgia Office of Insurance and Safety Fire.
Those who don’t already have health insurance and miss the Monday deadline can enroll until Jan. 15. But coverage wouldn’t start until Feb. 1.
What options are available for those who cannot afford health insurance?
Here are some resources available in Georgia for uninsured people.
- Many charity and low-cost clinics across the state operate on a sliding scale for low-income and uninsured people. Here are some directories to help find one near you.
- For DeKalb and Fulton residents, Grady Health offers financial assistance, often called a “Grady card,” for inpatient and outpatient care. For residents of other counties, Grady provides financial assistance for emergency services.
- Contact your health system or doctor and explain the situation. Hospitals are often able to write off debt, provide lower bills, or set up a payment plan. Just ask.
- Make sure you are being charged the lower “self-pay” rate rather than the insurance rate.
- Local public health departments offer an array of low-cost services, including vaccinations, many routine screenings like mammograms, and sexually transmitted infection prevention and treatment services.
- Eligibility for Medicaid varies. Typically, people who are eligible for the ACA are not eligible for Medicaid. Those who are eligible include:
- Children from low-income families
- Adults 19-64 with incomes up to 100% of the federal poverty level ($15,650) who work, volunteer, study, caregive or complete another qualifying activity for 80 hours per month.
- People with certain medical conditions or who are aged, blind, or disabled.
- Pregnant and post-partum women with low incomes.
- Parents of children under age 19 who earn very low incomes
Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.
