Officials warn expiring ACA credits will spike Nebraska insurance premiums

“I want to be really clear that Nebraskans with the lowest incomes will be the folks hurt the most if the enhanced premium tax credits expire.”

By Darsha Dodge, KOLN

(November 4, 2025)

Open enrollment began this week for millions of Americans, and for many—as tax credits from the Affordable Care Act near expiration — the cost of their premiums will increase by more than a thousand dollars.

ACA credits began in 2021 and were extended through 2025 by the Inflation Reduction Act.

Department of Health and Human Services reports show the number of Nebraskans on a Marketplace plan went from just over 74,000 in 2015 to more than 136,000 in 2025.

Chiquita Brooks-LaSure served as the Centers for Medicare and Medicaid Administrator during the Biden Administration. Brooks-LaSure told media on a press call Tuesday the U.S. had reached the lowest uninsured rate in history just before these actions.

“It’s actually worse than what many of us predicted. Early estimates are finding that premiums have increased by 26%,” Brooks-LaSure said. “Many people are seeing those their premiums skyrocket by hundreds to thousands of dollars.”

Brooks-LaSure said the goal of the Affordable Care Act was to ensure access and affordability within the system, something that will be effectively wiped out if these credits are allowed to expire.

“A 60-year-old couple in Nebraska that makes around $83,000 a year could see their annual premiums increase by over $22,000,” Brooks-LaSure said, adding, “a family of four earning $64,000 a year would see their annual premiums increase by almost $2,600.”

Projections from the Congressional Budget Office show permanently extending the tax credits would increase the federal deficit by $350 billion by 2035.

Omaha State Senator John Fredrickson, said the healthcare system relies on these subsidies as well — something that may force private insurance companies to raise their premiums in turn.

“It’s really pretty dire, what we’re facing and what we’re looking at,” Frederickson said. “And, as some of my peers have said before me, this is a decision, this is a choice that is being made ... There is this question about, should we be willing to forego things like, the healthcare premium cost affordability for folks. And I think there’s a really compelling argument to say no, especially when the paid for is to provide these tax cuts for some of the wealthiest Americans.”

The next legislative session begins Jan. 7, and the budget will be a central focus, with Frederickson adding the state’s response in shifts of federal law should be a top priority.

Kelsey Arends, health care access staff attorney at Nebraska Appleseed, said they’re anticipating 30,000 Nebraskans will lose Medicaid due to cuts, and another 15,000 will lose health insurance coverage if these ACA credits aren’t extended — with 93% of enrollees relying on these enhanced subsidies.

“I think there’s some discussion we’ve seen among our congressional delegation here in Nebraska about concern about higher income folks benefiting from subsidies,” Arends said. “I want to be really clear that Nebraskans with the lowest incomes will be the folks hurt the most if the enhanced premium tax credits expire.”

One of those Nebraskans is Audrey Horn. She and her husband live in Omaha, and have been on the ACA since 2019 because her husband works at a job that doesn’t offer health insurance.

Their premiums went up $688 a month.

“So far this year in 2025, out-of-pocket for prescriptions and everything, it’s about $10,000 in medical bills that we’ve spent this year — and we have insurance,” Horn said. “So obviously, we’re not getting a free ride. We have insurance, we’re getting a little help with the premiums.”

Brooks-LaSure, Frederickson and others on the call urged Nebraskans to contact their congressional delegation to demand action. Brooks-LaSure said the cuts are not inevitable, and Congress has the power to act to both continue the credits and prevent cuts to Medicaid.

“No one in this country should have to forgo health insurance because it is too costly. No one should face financial strains on their small business due to skyrocketing premiums, and no one should have to drive hours more for care because their rural hospitals shut down,” Brooks-LaSure added.

Nebraska Representative Don Bacon was part of a bipartisan group who issued a statement of principles to extend and reform the ACA credits, including a two-year extension and income cap.

Senate Majority Leader John Thune told Politico any extension would require the full 60 votes of the Senate.

“I feel like this whole shutdown is an attack on me. It’s an attack on me personally, and everyone like me,” Horn added.