Your health insurance is about to go up. Way up. Here's why.

If Congress fails to act, premiums could jump by hundreds or even thousands of dollars, especially in rural counties where fewer insurers compete.

By Chiquita Brooks-LaSure

Fifteen years after the Affordable Care Act (ACA) transformed American health care, families are again at risk of being priced out of coverage. This fall, legislation and actions by President Donald Trump and Republicans in Congress will raise costs by hundreds, maybe even thousands, of dollars a month for millions of working poor and middle-class people across the country. In some states, premiums could rise more than 20%, forcing families to choose between health insurance and other essentials.

The stakes couldn’t be higher. Since 2010, the ACA has made it possible for 24 million Americans to buy comprehensive, affordable coverage on the marketplace. Parents starting small businesses, adults between jobs, young people just out of college—all have benefitted from the law’s protections and subsidies. It has been especially life-changing for people with pre-existing conditions who can no longer be denied coverage or charged more simply for having been sick.

Before the ACA, if you weren’t insured through work, Medicare or Medicaid, your options were grim. People with cancer or diabetes were often denied coverage or charged exorbitant rates. Women were penalized simply for being women. Some states offered high-risk pools, but coverage was expensive and often kicked in only for catastrophic events. The ACA ended these abuses and, for the first time, created a fair marketplace where ordinary people could buy real insurance.

Like employer-sponsored coverage and Medicare, ACA marketplace plans rely on subsidies to make premiums affordable. These subsidies come in the form of tax credits, which adjust based on income. For millions of families who don’t get insurance through a job, those credits make the difference between having coverage and going without.

In recent years, the ACA marketplace has worked incredibly well because coverage was affordable and widely available—and millions enrolled. That stability has been possible thanks to enhanced tax credits, which both lowered premiums and extended help to middle-class families for the first time. A family of four earning about $64,000 could cover themselves for just over $100 a month, while a couple in their 50s making $93,000 saw their monthly premiums drop by more than $1,000.

Now those tax credits are set to expire. Without them, insurers know fewer healthy people will sign up, so they’re raising rates. Some states expect hikes of more than 20% compared with last year's 7% price increase. If Congress fails to act, premiums could jump overnight by hundreds or even thousands of dollars, especially in rural counties where fewer insurers compete. In HealthCare.gov states, costs are projected to rise an average of 93% for families losing eligibility. Combined with new rules that make enrollment harder, the result will be fewer healthy people in the market, higher premiums for everyone else, and millions at risk of losing coverage altogether.

This matters to more than just the people buying coverage today. Marketplace insurance is a safety net for anyone who might find themselves between jobs, starting a business, caring for a sick family member, or graduating into a first job without benefits. Any of us could need it one day.

Congress still has time to prevent this crisis. People should feel empowered to call their senators and representatives, leave voicemails, write letters, and demand action.

But subsidies alone aren’t enough. The bigger challenge is tackling the underlying costs of care itself, from prescription drugs to essential procedures such as dialysis and colonoscopies. That effort will take elected officials who are serious about lowering health care costs across the board, not just shifting the burden around.

The ACA proved that progress is possible. Now it’s up to us to make sure that progress isn’t rolled back and to push for the next steps toward a health care system that is affordable, fair, and sustainable for everyone.

Chiquita Brooks-LaSure is a former Centers for Medicare & Medicaid Services administrator.

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