Earlier this year, Angelia Hoomes’s back pain was so severe that she couldn’t bend down to put a cookie sheet in the oven. She was hiring others to load and unload her dishwasher. Any time she wasn’t taking care of her now 2-year-old granddaughter, she was lying in bed, practically unable to move. Hoomes—who is deeply involved in progressive politics in her local community in Macon, Georgia—will even have to sacrifice her proud position as a poll clerk in an upcoming January special election.

Her pain has improved since she had her first back surgery in October. But when Hoomes started making plans to schedule her second surgery, she faced a new anxiety: She had to make sure that the procedure would occur before the end of December.

“They kind of squeezed me in on the last surgical day of the year for that particular doctor, because with everything up in the air, I was just terrified to let my surgical window go into the new year,” said Hoomes. The company that provides her health coverage is switching from a PPO to an HMO plan in the new year, and her doctor is no longer listed as being in-network.

But even with her surgery successfully scheduled, Hoomes still has fresh worries in the form of the sticker shock that she will face in 2026, when the amount she pays for health care will jump by more than $1,000. Hoomes obtains coverage through the Affordable Care Act marketplace. Thanks to enhanced government-sponsored tax credits, her monthly premium cost is currently 20 cents. But with those subsidies set to expire at the end of the year, Hoomes’s options will become considerably more expensive: She said that she could choose between a plan that costs around $1,100 per month or one that is $1,300. She will opt for the cheaper plan but will need to use her monthly Social Security payment—also around $1,100—to cover the cost.

“There won’t be much eating out in my future, I can say that, but it’s just going to have to come from somewhere. No vacations, no new clothes, no new shoes. Just make do with what I’ve got,” said Hoomes, who is also a type 2 diabetic. She has a vegetable garden that she is hoping will help supplement her diet, and plans to barter fresh produce to obtain eggs from a neighbor with chickens.

Hoomes is 63 years old, meaning that she is still two years away from being able to obtain health coverage from Medicare. She retired from her job as a retention specialist for Geico in 2022 due to her back and neck pain, and has relied on the ACA marketplace to obtain health care ever since. The marketplace is her only option: Hoomes said that she does not qualify for Medicaid, the federally subsidized health insurance for very low-income Americans, because of her existing financial assets, including an inheritance from her parents.

Enrollees close to retirement age like Hoomes will be particularly affected by the expiration, in part because insurers are already permitted to charge more for older people than younger ones, so the rising premium cost will come on top of already higher prices. Hoomes’s home state of Georgia is one of the states that saw enrollment in the ACA marketplace more than triple after the premium subsidies were instituted, meaning that it will be particularly affected by the higher health costs.

Hoomes is one of more than 20........

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