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About 4 million Americans, including 88,000 Hoosiers, could lose their health insurance if the Affordable Care Act subsidies are allowed to expire at the end of 2025. (Photo/Pexels.com)

This story was originally published by Mirror Indy.

By Mary Claire Molloy
Mirror Indy
October 16, 2025

This week, Matthew Kubal picked up the phone and told dozens of people the cost of their health insurance is about to skyrocket.

On the other line, voices dropped. Some became angry, others teary, as they questioned the changes. When conversations got tough, Kubal looked at the collection of rocks on his desk, each representing a good memory.

“It’s almost like working at a mortuary,” the Indianapolis insurance broker said. “I’m constantly delivering bad news over and over again.”

Most years, he helps people enroll in plans from the Health Insurance Marketplace. This option was created under the Affordable Care Act, also known as Obamacare, for people who don’t qualify for health coverage through government programs and aren’t offered insurance by their employer.

About 300,000 Hoosiers are insured this way. But their plans are set to get a lot more expensive.

That’s because some government subsidies are set to expire this year, leaving people with less help to pay for their coverage.

Through the ACA, the federal government helped some Americans stay insured by paying for portions of their health plans. More people became eligible for this aid during the COVID-19 pandemic, when subsidies were expanded under the Biden administration.

But now, unless Congress acts, this financial assistance will go away. At the same time, insurance companies in Indiana are raising premiums, on average, by 20%.

“It’s a double whammy,” said Dr. Ryan Singerman, the president of the Indiana State Medical Association. “Costs go up and people either avoid care or ration it. And their health gets worse.”

As the federal government shutdown stretches into its third week, Congress has not acted to extend the enhanced ACA subsidies. It has become a key bargaining chip for Democrats, who say they won’t vote for a funding bill unless it keeps the subsidies going. Republicans, meanwhile, have largely said they are unwilling to do so as part of the funding bill, arguing the government must be re-opened before lawmakers negotiate on other issues.

But as the fight in Washington, D.C., continues, Kubal sits on the frontlines in Indianapolis. He hears from people who will become uninsured next year — the ones who will be priced out, praying they don’t have an emergency. Other families are weighing the cost of food, rent and the new premiums. And then there’s the small business owners trying to stay afloat.

“This puts people in a bad position, where they have to choose their priorities,” Kubal said. “There’s going to be suffering.”

‘Sicker and poorer’

In Indiana, 9 out of 10 people on marketplace plans receive the enhanced subsidies, according to federal data. And this help — based on income and household size — saves those Hoosiers about $427 on their health insurance each month.

Recent polling shows voters across the political spectrum want to keep the enhanced subsidies going.

Tracey Hutchings-Goetz is the policy director for Hoosier Action, a Medicaid advocacy group. She said Congress is responsible for the situation, but also pointed to insurance companies, who raised their prices in response.

Experts call it a death spiral: when insurance gets more expensive, healthier people tend to opt out. But people with more serious health needs stay, and insurance companies raise premiums to cover the expense.

“Insurance companies have made record profits in recent years,” Hutchings-Goetz said. “And yet they are not content. They’re passing on their increased costs to the average American.”

If people can’t afford their ACA premiums, many will go without insurance next year. Researchers from the Urban Institute, a national think tank, estimated the consequences: about 4 million Americans would become uninsured after 2025 without the federal subsidies. That includes 88,000 people from Indiana.

Hutchings-Goetz is thinking about the human toll.

“It’s going to make people sicker and poorer unless we do something about it,” she said. “People will not seek preventative care or get treatment early enough.”

Hospitals will ‘eat the costs’

The alternatives to the marketplace plans are shaky, too.

Medicare is only available for people age 65 or older or those who are disabled. People who get insurance through the marketplace would have to make less money to qualify for Medicaid. And President Donald Trump’s landmark tax and spending bill, passed earlier this year, included massive cuts to Medicaid that are expected to leave millions uninsured.

The pain reaches beyond patients.

“People who are uninsured don’t stop getting health care,” said Singerman, the Fort Wayne doctor who leads the state’s medical association. “And it’s the hospital systems that end up eating the costs.”

That might look like crowded ERs and higher health care costs across the board, even for patients who are not on marketplace plans. And some rural hospitals, Singerman said, might not be able to keep their doors open — driving the patients left behind to larger cities like Indianapolis for care.

“The cost is going to shift to those big institutions,” Singerman said. “By the time they get there, how much more sick are people going to be?”

‘The damage is done’

Even with the uncertainty, Kubal is preparing for open enrollment season.

Starting Nov. 1, appointments will fill his calendar from morning to night. With this year’s lost subsidies and spiking premiums, he needs to spend more time explaining the changes to clients. Tiny breaks are marked off in the schedule for meals and putting his 5-year-old daughter to bed.

Kubal still has hope that the enhanced subsidies will be extended. But he has to guide clients through what’s happening now.

“The damage is done,” the 42-year-old said, leaning back in his office chair. “If (Congress) had just acted earlier this year, the insurance companies wouldn’t have increased their rates that much.”

When being the bearer of bad news becomes too much, he picks up one of the rocks on his desk and fidgets.

Mirror Indy, a nonprofit newsroom, is funded through grants and donations from individuals, foundations and organizations.

Mirror Indy reporter Mary Claire Molloy covers health. Reach her at 317-721-7648 or email maryclaire.molloy@mirrorindy.org. Follow her on X @mcmolloy7.