Health insurance premiums could spike soon, if Congress doesn’t act.

Have you finished your shopping yet for this season? Sara Rubin here, thinking less about holiday gift shopping (that should be fun!), but about health insurance shopping because it’s the season for that too. Some 24 million Americans are being met with sticker shock as they look to enroll or re-enroll in health insurance for 2026. 

That is perhaps most apparent when shopping on health care exchanges, established by the Affordable Care Act of 2010. In California, the exchange is called Covered California. 

The concept is to apply market principles to a broader pool of prospective customers. Millions of people do not qualify for federal insurance policies (Medicare or Medi-Cal) and also may not have employer-provided insurance. The exchange gives you a platform to compare commercial plans and shop around.

Prices on the exchanges have also benefited from federal subsidies in the past, making expensive health plans (hopefully) within reach for regular people. If you have tuned in for even 30 seconds to the national news lately, you know that Congress cannot agree on whether to extend the most recent (2021) enhancement to these subsidies. 

The timing couldn’t be worse for Covered California, because open enrollment is happening now, with a Dec. 31 deadline for plans that start on Jan. 1. 

Covered California Executive Director Jessica Altman took a trip to Salinas yesterday, Dec. 17, and I asked her how enrollment is going this year amid the uncertainty in Washington. In short: not great. 

“There’s a lot of confusion about what’s happening and misinformation,” she told me. "We’ve never had an open enrollment where something is so uncertain in the midst of when people have to make these decisions.”

Last year at this time, there were about 330,000 new enrollees; that figure is down by 30 percent currently. “That definitely says either consumers are seeing headlines and not coming in, or they are watching and waiting—or seeing prices they are not willing to pay and not enrolling,” Altman says. 

The average increase in monthly premiums (that’s the amount you pay just to have insurance) is $150 statewide. For people earning over the $60,000 annual “cliff” that benefited from the enhanced subsidies now expiring, it’s $500. How on earth is anyone supposed to make that pencil out? 

Altman cannot answer that question for your household budget, but she can talk about the broader underlying concept of how and why insurance works, and how and why it’s a problem if fewer people end up enrolling. People who are sick or know they will need medical services in 2026 are likely to bite the bullet and enroll—they have no choice, even if it’s unaffordable. But people who are healthy and get insurance they might never use are critical players in the system—that’s how the insurance pool works out (whether it’s health insurance, car insurance or homeowner's insurance). Most customers tap into the pool infrequently, but they still pay into the pot; the collective helps support the insurer’s ability to pay out people in need. 

If you’re shopping for insurance on Covered California, I’d love to hear from you about what you’re seeing in terms of plans and pricing. Good luck.