If Congress fails to extend federal health subsidies before the end of the year, 400,000 Californians — 15% of them Black — could lose their health coverage, forcing many to go without insurance or pay sharply higher premiums.
Those federal subsidies, known as enhanced premium tax credits, were expanded during the pandemic to make monthly health insurance more affordable for millions of Americans who don’t get coverage through an employer. Without congressional action, the average Covered California enrollee could see premiums nearly double when the credits expire.
On Nov. 7, Oak Park residents gathered inside the small and intimate Classy Hippie Tea Co. to talk about what that looming change could mean for families and small business owners. The discussion, hosted by Covered California and community partners, brought together state health officials and nonprofit leaders to answer questions about open enrollment, health care affordability, and equity.
The timing came just days before the U.S. Senate passed a bipartisan bill to reopen the government, but without including an extension of those tax credits. The House of Representatives is expected to vote on the measure later this week.
The Oak Park conversation reflected a larger effort by Covered California to bring information into trusted community spaces, particularly neighborhoods of color where residents are more likely to be uninsured and where outreach from local messengers often makes the biggest difference.
Jessica Altman, executive director of Covered California, said the Affordable Care Act has been crucial in expanding health insurance across the state and that federal subsidies have helped provide coverage to roughly 400,000 Californians, 15% of whom are Black. She warned that those same Californians could lose their health insurance if Congress fails to extend the enhanced premium tax credits before they expire at the end of the year.
“They haven’t just made health care more affordable for people who already had it,” Altman said. “They’ve helped people gain coverage for the first time. Nationally, enrollment in marketplaces has doubled. Here in California, we’ve seen incredible increases in coverage, decreases in the uninsured rate, and, importantly, progress in closing racial disparities and creating greater equity in the process.”
Altman explained that Covered California serves people who don’t get coverage at work and don’t qualify for Medi-Cal or Medicare. The Affordable Care Act’s premium tax credits help those consumers afford monthly premiums. In recent years, the federal “enhanced premium tax credits” boosted that help, lowering costs for lower-income enrollees and, for the first time, making many middle-income consumers eligible too.
Those enhancements are set to expire unless Congress acts. “If these do expire … what a Covered California enrollee pays on average is set to increase by 97%,” Altman said. For most, that could mean premiums effectively double. She noted that for lower-income households, a $20 monthly premium could become $40, while middle-income families could see average monthly increases of about $500. “The result would be fewer people able to keep coverage,” she said.
Dr. Dawnté Early, president and CEO of United Way California Capital Region, recounted that before the Affordable Care Act, emergency rooms often were filled with people who delayed care because they couldn’t afford preventive visits. That led to “higher mortality” and “higher comorbidity,” with stark examples in maternal and infant health, she said. Coverage expansion helped reverse those trends, but losing the federal subsidies would ripple across the system.
“Even if you don’t care about those of us who are living in poverty … you should care about your own rates,” Early said, arguing that the system works better and costs less overall when more people are insured.
United Way also sees the link between health care and economic stability in its free tax-preparation program, which brought “over $40 million in tax refunds” back to local households in five years. Filing taxes, Early noted, can be essential to accessing premium tax credits.
Dr. Monica Soni, chief medical officer of the Health Equity and Quality Transformation Division for Covered California, described what broader coverage has meant inside clinics and hospitals: fewer late diagnoses, more preventive care, and people staying healthier and working. She recounted seeing patients lose work because untreated conditions spiraled — avoidable harm when coverage is within reach. The prospect of a sudden premium jump — “a 97% increase” — raised concerns about people in ongoing treatment who might be forced to pause care.
Altman and Soni spotlighted how every health plan offered through Covered California includes comprehensive behavioral health services, including treatment for substance use disorders. They noted that utilization of those services has shifted dramatically since the pandemic, with “over 70% of all behavioral health visits now happening through telehealth,” Soni said. Meeting people where they are — whether at home, in churches, barbershops, or community clinics — has helped reduce stigma and expand access to care.
Early pointed to community-driven solutions that work: delivering information and services through trusted spaces such as barbershops, salons, and churches; and pairing health care with housing and navigation support. Through CalAIM-aligned efforts, United Way housed a thousand individuals in the past two years including more than 400 children, according to Early. She also highlighted that some health plans are now investing in things like security deposits and community health workers. The throughline: health outcomes improve when social needs are addressed alongside clinical care.
That focus on meeting people where they are extends to how Californians access coverage. Altman said Covered California works with roughly 14,000 enrollment partners statewide — agents, clinics, and community-based organizations — to reach people directly at events such as farmers markets to health fairs. Those partners also can help residents enroll in Medi-Cal, Medicare, or county-based programs when those are the right fit.
An equity lens is also built into Covered California’s approach to health care and analyzes outcomes by how enrollees identify themselves to see whether the care is being provided equitably. “We know we’re not [delivering fully equitable care]. No one is,” Altman said. “But that transparency lets the program target gaps and move to this next phase of equity work.” Covered California plans to evolve financial accountability so it doesn’t only apply systemwide, but within specific communities, tying dollars to closing disparities.
If you have a card in your wallet, Soni said, use it, reminding people that a long list of preventive services carry no copay or coinsurance: cancer screenings (including colorectal screening starting at 45 and updated breast-screening guidance), diabetes and cholesterol screening, blood pressure checks, and recommended vaccines during respiratory-virus season. “Everybody should be utilizing those services and have a relationship with a primary-care doctor for other underlying needs,” Soni said.
She added that data show that particularly for Black patients, having a clinician who shares their background can increase life expectancy. “In a community with a high density of Black folks, if you actually have a high density of Black primary-care doctors, the whole community lives longer,” she said. “That’s not preference; that’s not just something we would like to have. It’s a life-saving intervention for us.”
Open enrollment runs through Saturday, Jan. 31; those who enroll by the end of December will be covered for the calendar year. And while roughly 6% of Californians remain uninsured, and despite the looming reduction in federal subsidies, Covered California encourages everyone to sign up for health insurance.
“Covered California is here to fight for Californians,” Altman said. “No matter what happens in Washington, we will be here … and we’re here to help.”
Options are available at CoveredCA.com, where applicants can compare plans and determine if they qualify for financial help.To find a certified enrollment counselor or agent nearby, Californians can visit coveredca.com/find-help.