RALEIGH, N.C. — Lea Charlton and her husband have faced significant financial burdens due to her heart condition treatment costs, compelling them to downsize their home a few years ago. Last year, she felt a sense of relief when she qualified for an Affordable Care Act (ACA) health plan assisted by tax credits. However, this relief turned to distress upon discovering her premium for 2026 would balloon to $1,825.82 per month—double that of her previous plan.
“This increase is seriously horrifying,” lamented the 60-year-old former occupational therapist, who has recently suffered several strokes. She expressed concern that they may need to sell their home again, incurring losses from the upgrades made after Hurricane Helene.
This dramatic price surge is attributed to the impending expiration of an expanded ACA tax subsidy program set to conclude at the end of 2025 without congressional action. Amidst a government shutdown, a Senate deal to vote on extending these subsidies emerged, though its passage remains uncertain in the House.
Insurance companies are preparing for a decrease in enrollment due to the removal of enhanced subsidies, predicting higher premiums for 2026. In North Carolina alone, nearly 1 million voters benefit from ACA subsidies—representing about 10% of the state’s population—with over 888,000 receiving enhanced premium tax credits, according to analysis from KFF, a healthcare research organization. It is anticipated that those relying on these enhanced subsidies may face premium increases of up to 114% next year.
The depletion of enhanced ACA subsidies arrives as a pressing concern for a community already grappling with healthcare challenges. Rural hospitals, many of which have been financially strained since the pandemic, have closed at alarming rates, with 12 hospitals shutting down in North Carolina since 2005. Charlton, who resides in Mitchell County, highlighted her local hospital’s pivotal role in saving her life during her medical emergencies.
Concerns extend to cuts made by Republicans’ One Big Beautiful Bill Act to Medicaid, which the North Carolina health department will seek federal funding to mitigate. Retiring Senator Thom Tillis (R) argued that these cuts could jeopardize rural hospitals and cost the state $32 billion in federal funds.
Democratic challenger Roy Cooper has criticized the bill’s impact on healthcare access, advocating for the continuation of ACA tax credits. During a recent news conference, Democratic state Senator Gale Adcock emphasized that voters see Democrats as defenders of affordable healthcare, contrasting this with Republican stances.
In a political landscape where both parties recognize the importance of healthcare costs, voters have expressed frustration toward the rising premiums. Independent voter Mike Cole from Raleigh criticized both parties, stating he and his wife are facing exorbitant costs for their healthcare after transitioning to gig jobs. Their combined premium has risen significantly, alongside an increased deductible, leaving them feeling overwhelmed.
While a consensus exists regarding the necessity to address healthcare concerns, the path to extending enhanced ACA subsidies remains complex. Some Republicans argue for serious reforms, citing structural flaws leading to inefficiencies and fraud within the subsidy program.
Further complicating the conversation, former Republican governor Pat McCrory asserted that both political parties share the blame in creating a healthcare climate plagued with rising costs. Voters are increasingly aware of how deteriorating financial management has impacted care access.
Pollster Brock McCleary suggests the true political ramifications of the healthcare debate will unfold next year, as voters may prioritize other concerns over rising premiums.
Despite the challenges, Charlton remains optimistic, believing healthcare will be a pivotal issue for voters in the upcoming elections. She has observed shifting sentiments among her rural neighbors who previously supported former President Trump but now face the burdens of escalating healthcare costs.
The participation of nearly 700 people in a recent local No Kings rally reflects a growing community awareness and willingness to stand against rising healthcare expenses, suggesting that the financial strain on families like hers may influence political outcomes in the near future.