A significant change in the legislative landscape may have profound financial implications for thousands of South Carolinians. The enhanced Affordable Care Act (ACA) subsidies, which have helped keep monthly insurance premiums affordable, are set to expire on December 31. These subsidies were initially expanded during the pandemic and extended by Democrats in 2022, providing lower monthly premiums for individuals who purchase health insurance through the federal marketplace. Without congressional action, the expiration of these subsidies may lead to substantial increases in costs statewide.
According to Michael Negron, a senior fellow for economic opportunity at the Center for American Progress, over 630,000 South Carolinians rely on ACA coverage, and the expiration of premium tax credits could result in significant “sticker shock” when premiums reset in January. Nationwide, more than 20 million Americans may be affected, with many enrollees facing average premium increases of over 100%. For example, a family of four earning $80,000 a year may see their monthly premium jump from $260 to over $560, resulting in a $3,000 annual increase.
The expiration of subsidies may have severe consequences, particularly in South Carolina, which has not expanded Medicaid. Many residents rely on ACA plans as a critical source of coverage, and without subsidies, some families may drop coverage or delay medical care. The South Carolina Hospital Association estimates that around 140,000 residents could lose coverage, while the Congressional Budget Office projects that approximately 4 million Americans nationwide may become uninsured.
Hospitals may also feel the impact, with the South Carolina Hospital Association anticipating a nearly $300 million increase in uncompensated care costs. This could strain rural hospitals and lower-income communities, where margins are already tight. While lawmakers are expected to revisit the issue in January, Negron advises families to prepare now by checking their enrollment status and exploring lower-cost plan options during open enrollment. Consumers are encouraged to review their options carefully, as lawmakers continue debating whether to extend the ACA subsidies.