Celeste Meyer, 38, went years without health insurance, because she just couldn’t afford it. Then one day in 2022, as she hoped to become pregnant and saw premiums were manageable, she bought a plan on the Affordable Care Act exchange.
She didn’t know it, but the price she paid was only affordable because of new government subsidies she qualified for. Most of those subsidies will expire at the end of 2025, when premium prices will go back up nationwide for many. Experts expect the ACA’s insured rolls to plummet.
Meyer, a therapist in metro Atlanta, is now about to insure her family of three, and she says the premium she will pay each month is about $450. Without federal subsidies, she says, her bill would be just over $1,500 a month.
Meyer’s decision to buy insurance that day made her one of more than 800,000 Georgians added to Georgia’s ACA rolls following new federal “enhanced subsidies,” enacted by Congress during the pandemic. Enrollment has soared nationwide since they went into effect, with the biggest jumps being in states with large numbers of uninsured poor: Georgia, Mississippi and Texas.
Congress can act to extend the enhanced subsidies, but a proposal to do that fell to the wayside in December. Although incoming President Donald Trump has not said what he wants to do with the ACA subsidies, they could be lost as he looks for budget cuts to fund promised tax breaks. Experts at the research organization KFF have said the “math is inescapable” that those subsidies are on the table. Extending them would cost about $335 billion over 10 years, according to the Congressional Budget Office.
The Congressional Budget Office estimated that about 28% of Americans on ACA plans would drop their coverage over 10 years if the extra subsidies end. In Georgia, according to KFF, prices would rise on average 85%, hitting the middle class — like Meyer — hard.
Without the enhanced subsidies, a Georgia family of four making $130,000 a year and paying $921 a month for coverage would see their federal subsidy disappear, and their monthly premium increase to $1,647, according to KFF. KFF is a nonprofit health research organization based in Washington, D.C.
But even the low-income earners would be hit by the loss of subsidies. The left-leaning Urban Institute estimated that 336,000 Georgians would drop coverage and go uninsured, mostly among those near the poverty level. The poverty level for an individual living alone is income of $15,060 per year, and for a family of four is $31,200 a year.
The Congressional Budget Office estimated that if the enhanced subsidies are not renewed, enrollment nationwide would drop by 3.9 million in the next enrollment window.
A booming open enrollment
For now, sign-ups for ACA plans covering 2025 are going gangbusters.
Two million new shoppers signed up so far in the 31 states that use the federal ACA website, the U.S. Department of Health and Human Services announced in December, a new record. In Georgia, with a record 1.3 million sign-ups last year, business is on track to outpace the previous year’s record numbers, even with the changeover to a new state-based website, GeorgiaAccess.gov, a Georgia Access spokesman said.
Elise Brown, a “navigator” in Atlanta at the Georgia Legal Services Program who helps people sign up for ACA plans with unbiased advice, said the new state website and having affordable plans to offer have made for an especially busy year. She spoke to a reporter in a few minutes between phone calls with clients.
“The experience has been positive, it really has been,” she said. “When they come to us, they come overwhelmed, I would say. But once we’re finished, they come away just happy.”
For 2025, Meyer has now signed up not just her and her baby, but added her partner as well. Up until now, he’s been uninsured like she used to be.
The insurance means her partner can get cardiac care more easily. His father died young of a heart attack, and Meyer’s partner recently had his own minor heart scare. After spending a month wrangling paperwork to get a needed heart checkup without insurance, Meyer said he was able to quickly get an appointment with his new ACA insurance.
“I was ecstatic that we were going to be able to all have health care this year,” Meyer said.
How the ACA subsidies work
The ACA marketplace exchange is also known as Obamacare, and in Georgia, people buy the subsidized insurance plans through the new Georgia Access program at the website GeorgiaAccess.gov. Even with a state website, most of the subsidies come from federal money. Georgia has its own smaller subsidy program called reinsurance, and that also helps people in middle- and higher income brackets like Meyer.
The federal ACA marketplace opened in 2013 and has always subsidized many premiums. But Congress didn’t give it enough funding to subsidize premiums at all income levels. As insurance shoppers’ incomes rise toward middle class and beyond, the subsidies faded and then disappeared.
As originally drawn up, the subsidies stopped completely at the point where a household makes 400% of the federal poverty level. People who earned more had to pay full market price for the insurance. That income cliff would be $60,240 for an individual living alone, or $124,800 total household income for a family of four.
Meyer’s income has in most years put her in a bracket for smaller subsidies.
In the midst of the pandemic in 2021, Congress and President Joe Biden enacted “enhanced” subsidy funding to do more. The enhanced subsidies were larger and helped more people.
The result for people like Meyer, in the middle class: The price tag she was offered for monthly premiums dropped hundreds of dollars. For lower-income households just above the poverty level, premiums went from maybe $5 to zero, a huge change for them. More than 600,000 of those lower-income people joined after 2020, the biggest group added.
Georgia’s overall ACA enrollment has jumped from 464,000 in 2020 to 1.3 million in 2024, an increase of 841,000.
Advertising enacted by Gov. Brian Kemp’s administration for Georgia Access has helped. But the biggest driver, as in other states, has been the federal subsidies, said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms. “Price is still king,” she said.
Meyer didn’t know until a reporter spoke to her that the enhanced subsidies her family is getting are scheduled to disappear. They’ll have to choose who in the family they can afford to keep insuring and who will have to go uninsured. It might be her partner: He stays home with their baby because child care is so expensive it would eclipse his salary. Being officially unemployed, he might be able to find care through the Grady Health System.
“There’s definitely a feeling of dread,” she said. “What are we really choosing here — like who’s going to have access and who isn’t? It’s exasperating to have to do all this mental math around who gets to be healthy and who gets to feel safe in their bodies.”
Credit: Ariel Hart
Credit: Ariel Hart
About the Author
