These small business owners will become uninsured after key ACA subsidies expire

(CNN) — When patients come to Eric Frankenfeld’s chiropractic practice with insurance woes, his wife, Lisa, the office manager, tells them not to worry because she’ll work with them to keep care affordable.

But starting in January, the Frankenfelds might need to ask for the same treatment from their own doctors, since they will become uninsured. The Point Pleasant, New Jersey, couple will no longer be able to afford their Obamacare plan after the enhanced premiums subsidies lapse at year’s end. They decided to forgo coverage after learning that their plan’s premium will skyrocket to $1,928 a month, up from $340 this year.

Though they are both healthy, the idea of losing coverage keeps Lisa Frankenfeld, 62, up at night — worrying one of them might be diagnosed with cancer, suffer a stroke or heart attack or get into a serious accident.

“We are health care providers who cannot afford benefits. Oh, the irony,” she told CNN. “Purchasing a plan doesn’t make financial sense. We’re just going to cross our fingers and hope for the best.”

The Frankenfelds are among the millions of Affordable Care Act enrollees who are facing tough decisions this open enrollment season, which ends January 15 in most states. More than 90% of ACA policyholders — or about 22 million people — receive the enhanced subsidies, which spurred record sign-ups for Obamacare coverage this year.

A sizeable share of those enrollees are self-employed or own or work at small businesses. Nearly half of adults in the individual health insurance market — the vast majority of which is purchased through Obamacare exchanges — are affiliated with a small business, according to KFF, a nonpartisan health policy research group.

Employer policies are often too pricey for small businesses and for those who work for themselves, leading many to turn to the Affordable Care Act exchanges. And even though several told CNN their Obamacare coverage requires they spend a lot out of pocket for care, they say it’s still better than being uninsured.

However, without the enhanced subsidies, which were enacted by the Biden administration as part of a 2021 Covid-19 relief package, enrollees’ premium payments are expected to jump 114%, on average, next year. The provision’s lapse also means that consumers who make more than 400% of the federal poverty level — about $62,600 for an individual and $84,600 for a couple — will no longer qualify for any federal aid.

The House is set to vote in January on extending the beefed-up assistance for three years after four Republicans bucked their caucus and supported a Democratic proposal. But the measure faces a difficult path in the Senate, which voted down a similar Democratic bill earlier this month.

The potential to lose everything

Increasingly squeezed by the rising cost of electricity, groceries, personal and business insurance and supplies for their garage door installation and repair company, Kathy and Jeffrey Many of Brandon, Vermont, decided not to renew their Affordable Care Act coverage for 2026. The premium for their plan is shooting up to nearly $2,670 a month, from $625 this year. The cheapest one they could find is nearly $1,870 a month.

Although the couple had high out-of-pocket costs for care, their Obamacare policy gave them peace of mind in case one of them had to deal with a major illness or accident, Kathy Many told CNN. Being uninsured next year will be “very nerve-wracking,” she said.

“Every time Jeffrey leaves to go out on a job, I’m going to be like ‘Jesus Christ, I hope nothing happens to him today,’” said Many, 61, her voice breaking, “because everything that I’ve worked my whole life for could be lost to bankruptcy.”

Instead of having health insurance, Many plans to sock away the $625 a month they were paying this year and “pray” that it will cover their health care expenses until her husband enrolls in Medicare in the fall and she qualifies in 2029.

A lot of enrollees have been waiting to explore their Obamacare options because they didn’t want to learn how much they would have to pay for coverage come January.

Jeff , a freelance musician from New York City who earns so little that he did not have to pay a premium this year and last year, waited until mid-December to sign onto his state’s exchange. When he saw the cheapest plan for 2026 would cost him $275 a month, he closed his laptop since he knew he couldn’t afford it and would become uninsured. Instead, he went back to searching for a gig to replace one he just lost.

The fact that Republicans in Congress are not renewing the enhanced subsidies infuriates Jeff, 50, a registered Democrat who asked that his last name not be used to protect his privacy.

“We can find money to build an arch and a ballroom that are completely unnecessary and tax cuts for billionaires,” he said, referencing President Donald Trump’s construction plans and the GOP domestic agenda package that passed this summer. “But we can’t insure people medically in this country. It’s unconscionable.”

Some small business owners, however, can’t afford to go without health insurance because they have medical conditions and need care. The spike in premiums is forcing them to consider big decisions.

Sonja, who owns several real estate businesses with her husband, said they are looking into joining with another company in the hope that they can obtain group health insurance with lower premiums if they have a larger workforce. She asked not to include her last name to protect her and her business’ privacy.

The Minnesota couple will have to shell out more than $2,150 a month next year to cover themselves and their daughter, up from roughly $1,000 this year. Sonja, 49, is not willing to go without insurance, especially after her husband had to have surgery this year, though the higher premiums might force them to sell part of their holdings or stop saving for retirement.

“In the event that we would have a major health issue, paying for insurance would be a much better spend than being uncovered and opening ourselves to the potential of losing way more,” she said.

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