Amid another bout of political gridlock, millions of consumers who rely on the Affordable Care Act will lose enhanced health insurance subsidies.

Unless Congress acts, the enhanced subsidies will expire at the end of 2025, with higher premiums taking effect in 2026. Roughly 22 million recipients, or about 92% of Affordable Care Act marketplace enrollees, will see their insurance premiums rise. The nonpartisan health policy research group KFF estimates the average recipient could see their premiums more than double with the disappearance of the subsidies. The Congressional Budget Office also estimated that 2 million people will become uninsured with the subsidies lapse. 

Swampscott does not have data on the number of residents enrolled, according to the Public Health Department. In Massachusetts as a whole, health care reform in the Commonwealth and the subsequent implementation of the Affordable Care Act led to increased use of primary care and preventive services, according to the Center for Health Information and Analysis.

The Affordable Care Act expanded health insurance access by creating a marketplace for subsidies for people who do not qualify for Medicaid and are not covered through an employer. The law provided more Americans with access to private health insurance plans. The federal statute was signed into law by former President Barack Obama in 2010. The subsidies take the form of premium tax credits available across income levels.

Lauren Shrestha, the chair of Swampscott’s Commission on Disabilities, said subsidies can help pay for things like the Massachusetts Health Connector plan, “which is something that a lot of people who don’t have regular coverage usually have to get.”

The enhanced subsidies boost the value of premium tax credits, making coverage more affordable for households. They applied to those in households with incomes between 100% and 400% of the federal poverty level. It also capped out-of-pocket premium costs at 8.5% of a household’s annual income.

Congress temporarily enhanced the subsidies in 2021 as part of the American Rescue Plan COVID-19 relief package. The expanded subsidies reduced the monthly premiums, in some cases as low as $0 for low-income enrollees. The expansions were extended through 2025, and enrollment has doubled since 2020.

According to the Urban Institute, the average annual premium is projected to rise to about $8,500 in 2026, up from $4,400 this year. A one-person household with an annual income of $25,000 is estimated to pay $1,168 annually out of pocket, an increase from the previous maximum of $100.

Early retirees, middle-income families, small business owners, and residents in lower-income states are among those most vulnerable to the price hike. People between the ages of 55 and 64 are the highest enrolled in the marketplace.

In Swampscott, over a quarter (29%) of the population is between 50 and 69 years old, according to Census data.

Heidi Whear, the director of aging services, did not respond immediately for comment.

“Swampscott has a larger, older population,” Shrestha said. 

The 2023 Census data also shows that about 7% of the 15,209 people living in town are below the poverty line. In the same year, 0.85% of people were uninsured in Swampscott, with about 11.4% receiving insurance outside of Medicaid, Medicare and employer coverages.

Another group likely to be significantly affected by the loss of the enhanced subsidies is people with disabilities who rely on the Affordable Care Act marketplace for health insurance. Those with disabilities tend to need more comprehensive coverage, and they are more likely to be self-employed. 

In addition to the end of the subsidies, a spending bill President Donald Trump passed earlier this year can make it more difficult to maintain coverage.

“People with disabilities often, for various reasons, don’t have access to employer sponsored care,” Shrestha said. “Massachusetts does have some stuff for people with disabilities, but it would definitely not be ideal if the tax credit got rolled back…It would negatively impact them, even with all of the support Massachusetts has in place.”

In Massachusetts, KFF shows an 89% increase in premium payments without the enhanced tax credits. The average monthly silver premium for a 60-year-old with no subsidies will cost $839.

Following the implementation of Massachusetts’ 2006 health care reform as well as the federal Patient Protection and Affordable Care Act, Commonwealth residents have had the highest rates of insurance coverage in the nation, according to the Center for Health Information and Analysis’ April 2022 report. 

“However, high rates of health insurance coverage among residents overall may obscure differences  that exist across the different geographic regions of the Commonwealth,” the report reads. “In particular, historical factors such as residential segregation, limited availability of affordable housing, and reduced access to high paying jobs in certain geographic regions may create systemic challenges that make residents such as racial/ethnic minorities, low income workers, and foreign-born residents with limited  English proficiency, more vulnerable to transitions in health  insurance coverage.”

Many Republican lawmakers, however, have said they oppose extending the Affordable Care Act subsidies, citing concerns about cost and fraud. KFF, though, found that 84% of marketplace enrollees – which was almost all Democrats and nearly 75% of Republicans – said the tax credits should be extended.

Other House Republicans – such as Reps. Brian Fitzpatrick (Pennsylvania), Monica de la Cruz (Texas), Maria Salzar (Florida) and Jefferson Van Drew (New Jersey) – joined Democrats to force a vote in January to potentially extend the subsidies. If passed, it would still need to face the Senate, where Republicans voted down a three-year extension on December 11.

A GOP bill, called the Lower Health Care Premiums for All Americans Act, was passed in the House of Representatives in the middle of December to expand association health plans, enabling small businesses to join together and offer larger group coverages and fund cost-sharing reductions. The proposed changes would potentially increase the uninsured population by about 100,000 people, saving the government $35.6 billion over the next decade, according to the Congressional Budget Office.

Although the higher premiums are set to take effect January 1, Congress could still pass a retroactive extension.