Approximately 300,000 Oklahomans who rely on the Affordable Care Act Marketplace for health insurance are being left in limbo as federal lawmakers scramble to address rising insurance premium costs, with enhanced premium tax credits set to expire at the end of the year.
Healthinsurance.org health policy analyst Louise Norris is encouraging Oklahomans to pick a plan now and pay attention to federal efforts that may move into 2026.
The vast majority of Oklahoma’s ACA Marketplace consumers benefit from enhanced premium tax credits. The state saw a significant increase in enrollment between 2021 and 2024 through these enhancements, which were introduced under the American Rescue Plan Act and extended through the Inflation Reduction Act.
They provide additional assistance to those already eligible for the regular tax credits and expand eligibility to enrollees with incomes above 400% of the federal poverty level. Many enrollees have paid $0 monthly for coverage through the seven insurance carriers operating in Oklahoma’s Marketplace.
If the enhanced credits end, people will have to pay a larger share of the premiums. On average, the rates will more than double. Those over 400% of the federal poverty level would also no longer be eligible for assistance.
State-level estimates from the Center on Budget and Policy Priorities show a 60-year-old couple earning $85,000 – or 401% of the federal poverty level – would see a yearly premium increase of $23,559.
The U.S. Senate failed to advance two health care proposals last week, leaving the House to vote on its own measure before the holiday break. The House GOP health care bill is set to hit the floor on Wednesday.
The bill, presented by Speaker Mike Johnson and other Republican leaders, offers alternative policies. It does not extend enhanced premium tax credits. Johnson said Tuesday he will not allow a House vote this week to extend them.
What does House Republicans’ plan currently include?
It seeks to expand access to association health plans, allowing small businesses and self-employed people across industries to join together to offer what amounts to less-regulated large group coverage rather than having to obtain individual or small group plans.
Small group plans have to cover essential health benefits – like maternity and newborn care, mental health treatment and prescription drugs – and cannot base premiums on the group’s medical history. Those rules don’t apply to large groups.
“This would appeal to self-employed people who are healthy and who don't want the robustness of ACA-compliant coverage, but that would leave sicker people in the risk pool of ACA-compliant coverage,” Norris from healthinsurance.org said.
The bill would also codify CHOICE Arrangements, which is a rebranding of Individual Coverage Health Reimbursement Arrangements that have been available since 2020. They offer a way for employers of any size to reimburse employees for the cost of individual-market health insurance or Medicare, and other qualifying medical expenses, if allowed by the employer.
This is in place of offering group coverage to employees.
Under current rules, this arrangement can be used to pay or reimburse employees for individual market coverage purchased through or outside the ACA Marketplace. If the employer contribution doesn't cover the full premium, the employee is responsible for covering the remaining portion.
If the employer offers employees the option of using a pre-tax salary reduction to pay their share of the premium, that can only be used if the plan is purchased outside the Marketplace.
The House GOP bill would allow employees to utilize pre-tax salary reductions, if offered by the employer, to cover their share for a plan obtained in the Marketplace.
“There are really no red flags about that. It's not problematic because, of course, all the plans sold in the Marketplace are fully ACA-compliant. It's not expanding access to subpar coverage,” Norris said.
Finally, the bill seeks to appropriate money for cost-sharing reductions, which reduce out-of-pocket costs for eligible enrollees who select silver health insurance plans in the Marketplace.
They lower a health plan’s out-of-pocket maximum and increase the actuarial value of the plan. That value is used to measure the percentage of total medical costs that a plan will cover for an average population.
“Basically, what that does is it reduces your deductible, reduces your out-of-pocket maximum, reduces your co-pays,” Norris said. “It just means you don't have to pay as much when you go get health care.”
Norris said for several years, the federal government paid insurance companies for the cost of providing that benefit. In 2017, the first Trump administration cut off that funding.
To address this, Norris said insurance companies and regulators in almost every state added the cost of providing that benefit to silver plan premiums. The result was that, since silver plan premiums became higher, everyone’s premium tax credits increased because they are based on the cost of silver plan coverage, Norris said.
“The people who qualify for those cost-sharing reductions, especially if their income isn't more than 200% of the poverty level – that's the vast majority of folks who enroll in silver plans – they get a premium subsidy based on the cost of that silver coverage, so they're good,” Norris said. “People who buy gold and bronze plans get larger subsidies, so they're good.”
If Congress were to start funding these reductions, Norris said, it would harm almost everyone.
“It would basically reduce the price of silver plans, which would drive down the amount of premium subsidies,” Norris said. “The only people who would come out ahead would be people who don’t qualify for premium subsidies but who want to buy a silver plan because the full price cost of those silver plans would go down.”
Norris said even if the House approves this proposal, it’s unclear whether the Senate would pick it up this week.
“I would say the odds are not great at this point that anything actually gets done before Congress goes on their winter recess. But that doesn't mean this is over,” Norris said. “If nothing happens before they head out on their recess, this issue could certainly be picked back up again in the new year.”
For now, Norris said what people see as they get on the Marketplace is “the worst case scenario.”
“It’s possible, although I would say no longer likely … we could see an improvement at some point in the future. But it won't be any worse,” Norris said. “So the premiums you're seeing right now, you can make your decision based on that, knowing that it's not like those subsidies that you're seeing now are going to go away.”
She encourages Oklahomans to pick a plan now based on what they can afford and keep an eye on what federal lawmakers decide to do.
“You just really want to pay attention to how your plan is changing for 2026 because you don't want to find out when you go to the pharmacy or when you go to the doctor or need care and be surprised by it at that point,” Norris said.
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