Across the United States, families are waking up to startling news about their health insurance for 2026. In Virginia Beach, one household discovered their deductible will skyrocket from $800 to a staggering $20,000. About 200 miles north, a Maryland family learned they’ll pay an extra $500 every month to keep their coverage. Meanwhile, thousands of Idaho residents were greeted with premium increases averaging $100 per month. The picture is the same nationwide: millions of Americans are facing sticker shock as open enrollment for Affordable Care Act plans begins in select states.
The cause? The enhanced federal subsidies introduced in 2021 to make ACA coverage more affordable are set to expire at the end of this year—unless Congress acts. But lawmakers remain gridlocked, leaving states, insurers, and consumers scrambling to prepare for every possible scenario.
On October 1, the federal government shut down after Congress failed to allocate the roughly $353 billion over the next decade needed to extend these subsidies for roughly 24 million Americans. Republicans have insisted that Senate Democrats must first vote to reopen the government before they will negotiate on ACA costs. Democrats, meanwhile, are calling for a continuation of these subsidies to avoid leaving millions uninsured or underinsured.
The stakes are enormous. If a deal is reached in the coming days or weeks, it could drastically alter the types of plans available, the prices consumers pay, and the very mechanics of open enrollment, which begins on November 1 in most states. Yet the uncertainty has left state-run exchanges in a race against time.
Michele Eberle, executive director of the Maryland Health Benefit Exchange, described the challenge: “We will do whatever it takes to make sure we can provide Marylanders with the most affordable health coverage,” she said. “The mechanics of how that gets done, we don’t really know until we figure out what Congress might do. Everyone realizes that we just can’t flip a switch overnight.”
Even with backup plans in place, Maryland residents face higher premiums, with the state expecting an average increase of 35% next year. Notices reflecting these hikes—based on the assumption that federal subsidies will expire—are already in households and inboxes. One middle-income Maryland family of four, for instance, will see their monthly premium jump from $916 to $1,427.
Most states still rely on healthcare.gov, the federal marketplace, for enrollment. The Centers for Medicare & Medicaid Services (CMS), which manages the site, declined to speculate on how quickly they could implement changes if Congress acts after enrollment begins. “CMS does not speculate on potential Congressional action,” said Emily Hilliard, a spokesperson for Health and Human Services.
States that run their own ACA exchanges, like California, are preparing contingency plans as well. Letters have gone out to policyholders detailing 2026 costs under the assumption that federal subsidies will end. “At no point is it too late,” said Jessica Altman, executive director of Covered California. “We are ready to move any mountain we can possibly move to make changes as quickly as possible.”
California estimates that it could take about a week to reprogram its online marketplace to reflect new pricing if Congress approves the subsidies exactly as they currently exist. Insurers themselves have submitted two sets of premium rates this year: one assuming subsidies continue and another assuming they expire. Many shoppers, however, are being presented with the higher rates that would take effect without federal assistance.
These increases are not arbitrary. Insurers warn that if subsidies expire, healthier, younger customers may drop coverage rather than pay more, leaving a sicker, older pool behind. If Congress reaches a deal, premiums could be adjusted downward—but timing is critical.
The complexity of the situation is evident from state to state. In Virginia, some households face premiums that seem manageable but come with prohibitive deductibles. Deepak Madala, director of Enroll Virginia, described the challenge: a family in Virginia Beach with an $800 deductible now faces a potential $20,000 out-of-pocket cost to keep a similar monthly premium. “They’re deciding whether to go without coverage or switch to a plan with a very high deductible,” he said.
In Pennsylvania, the state-based exchange reports a 102% premium increase for its roughly 500,000 customers, with about a third expected to drop coverage entirely. Idaho, which opened enrollment early on October 15 and will close by December 15, faces a particularly tight timeline. With average increases around 75%, about 20% of enrollees may exit the marketplace. Pat Kelly, executive director of Your Health Idaho, explained that any congressional action after mid-December would leave the state with insufficient time to make changes before the enrollment window closes.
Across the country, states are racing against the clock. Exchanges are ready to update plans, insurers are ready to adjust premiums, and consumers are bracing for dramatic changes in what they’ll pay for healthcare. The looming deadline creates unprecedented uncertainty—one that could affect millions of Americans’ access to coverage, financial stability, and peace of mind.
In short, the countdown to open enrollment this year is more than a calendar—it’s a test of coordination, flexibility, and political compromise. Every day that Congress delays a resolution increases the stakes for families, insurers, and states alike. For millions of Americans, the clock is ticking, and the race for affordable, accessible healthcare has never been more urgent.