At least a dozen states are moving to blunt health insurance premium hikes after Congress failed to renew enhanced subsidies under the Affordable Care Act, leaving millions of Americans facing higher out-of-pocket healthcare costs.
According to reporting by Politico, states including California, Colorado, Maryland and New Mexico have approved or are considering temporary measures to help residents afford coverage.
However, officials in many states warn that fully replacing the lost federal support would overwhelm state budgets.
“We can carry the cost for a little bit, but at some point, we will need Congress to act,” New Mexico House Speaker Javier Martínez told Politico. New Mexico is so far the only state to fully replace the expired subsidies using state funds.
The enhanced subsidies, which lowered premiums for millions of people buying coverage on the individual market, expired after Congress failed to agree on an extension during contentious budget negotiations.
Their lapse is expected to push millions out of marketplace plans, increasing pressure on state Medicaid programs and hospitals already facing financial strain.
State responses have varied widely. California, which anticipated the subsidies would expire, is spending nearly $200 million to support roughly 300,000 lower-income residents, though state officials caution that hundreds of thousands more could still lose coverage.
Other states are relying on regulatory adjustments rather than direct spending to stretch remaining assistance.
By contrast, states such as Georgia and Washington have said budget constraints or political opposition prevent them from acting.
Most states have taken no action at all, including both Republican-led states opposed to the Affordable Care Act and some Democratic-led states that generally support it.
Some lawmakers have also expressed concern that aggressive state-level interventions could reduce pressure on Congress to enact a federal fix. In Maine and other politically competitive states, officials worry that stepping in too fully could delay national action.
At the federal level, bipartisan discussions are ongoing but unresolved.
Senators Susan Collins and Bernie Moreno have outlined a potential framework to extend the subsidies for two years while adding income caps and other cost controls, but no bill has yet passed either chamber.
Any eventual deal is widely expected to involve a short-term extension of subsidies paired with Republican-backed guardrails. Until then, states are left to decide how much of the financial burden they can absorb as millions of Americans brace for higher health insurance premiums.
