Washington's Economy Faces Collapse as 80,000 Residents Risk Losing Healthcare From Expiring ACA Subsidies

Small business owners across Washington face a daunting challenge. In 2026, health insurance premiums will climb by 21.2 percent, a punishing increase for freelancers, shopkeepers, and startups already struggling to make ends meet. This threat endangers the livelihoods of those who drive our local economies. The Affordable Care Act’s enhanced premium tax credits, which support 77 percent of the state’s 309,000 Marketplace enrollees, expire on December 31, 2025. Without them, 80,000 residents risk losing coverage entirely.

Access to affordable healthcare shapes lives and communities. For small businesses, it determines whether they can expand or shutter. For the self-employed, it means seeing a doctor without facing financial ruin. Washington has committed $150 million to state subsidies, but a $15 billion deficit limits its reach. Federal action is essential to prevent disaster, and the urgency is undeniable.

Premiums for small firms have surged over the past two decades, rising 120 percent for individual plans and 129 percent for family plans. Today, only 30 percent of small employers offer coverage, compared to 50 percent in 2000. Businesses earning under $600,000 in revenue face a 12 percent payroll burden for insurance, nearly twice that of larger firms. This imbalance crushes ambition and demands a robust response.

Expiring subsidies would unleash chaos. Premiums could soar by 72 percent, overwhelming families and individuals. Picture a Tacoma baker, balancing rising costs and a mortgage, now forced to pay $600 monthly for coverage. Many will abandon insurance, swelling the ranks of the 80,000 at risk of going uninsured. These choices lead to skipped checkups, untreated conditions, and mounting fear.

The consequences extend further. Losing younger, healthier enrollees will destabilize insurance markets, pushing premiums even higher. Hospitals, already strained, will grapple with uncompensated care costs. Black and Hispanic communities, who depend on these subsidies, will face disproportionate harm, widening healthcare gaps. How can we justify letting our neighbors suffer when solutions exist?

Nationally, the outlook is dire. Without subsidies, 7 million could lose Marketplace coverage, and 4 million may become uninsured. Premiums could rise 75 percent, hitting low-income households hardest. The West Health-Gallup Healthcare Affordability Index reveals 35 percent of adults can’t access quality care, a historic high. We must act to protect vulnerable families and stabilize our healthcare system.

Some policymakers advocate for deregulation, block grants, or Medicaid work requirements, claiming these will lower costs. History tells a different story. The 1996 HIPAA portability rules, meant to enhance flexibility, triggered adverse selection and higher premiums. Short-term plans and health-sharing ministries often fail consumers, leaving them exposed to catastrophic costs. These approaches prioritize profit over people and lack staying power.

Proposals like those in Project 2025 seek to cut federal oversight and Medicaid benefits, shifting burdens to states. Washington, facing a massive deficit, cannot absorb these costs. Block grants would reduce funding, slashing vital services. The 2010 COBRA subsidy expiration demonstrated the fallout: enrollment dropped, providers struggled, and patients lost access. The ACA’s subsidies, by contrast, have slashed benchmark premiums by 44 percent and driven enrollment to 21 million. Why abandon what works?

Extending ACA premium tax credits permanently offers a proven path forward. Senators Jeanne Shaheen and Tammy Baldwin, joined by Representative Lauren Underwood, have proposed legislation to secure these subsidies, preserving affordability and market stability. Their efforts build on gains that doubled Marketplace enrollment since 2020. Even Senators Lisa Murkowski and Thom Tillis recognize the need for bipartisan action. The moment for unity is here.

Washington’s 2025 Silver Load adjustments show state-level commitment, but they’re temporary. Permanent federal subsidies would provide certainty for insurers and enrollees alike. CBO projections indicate millions would retain or gain coverage, and state subsidy programs demonstrate that consistent funding prevents market upheaval. This approach ensures healthcare remains within reach for all, not just the privileged.

The call to action is urgent. Advocacy groups are pressing for swift congressional action. Notably, 88 percent of new Marketplace enrollees since 2020 hail from states that supported Trump, proving this transcends party lines. We must protect 80,000 Washingtonians and millions nationwide from losing care. Bold, compassionate policy can secure a healthier future for everyone.