News

City business owner among those hit with 'potentially catastrophic' premium increases

By Lucas Thomae, Carolina Public Press, Published: January 15, 2026

For months, Adrian Pitts followed the news with bated breath as Congress fought — and eventually shut down the federal government — over whether to extend COVID-era subsidies for Affordable Care Act marketplace health plans.

Pitts, a 57-year-old small business owner and Hendersonville resident, was one of the beneficiaries of the enhanced premium tax credits which greatly reduced the out-of-pocket costs for millions of Americans who are covered under the ACA. Waiting to see whether he’d have to pay thousands more for his health insurance in 2026 was stressful, Pitts told Carolina Public Press.

The open enrollment period began in November without a deal in sight. Then, the government shutdown ended with a meager promise from Republicans to bring the issue to a vote in January, after most enrollees had already been locked into their insurance plans for the new year.

Pitts, who has a Blue Cross Blue Shield plan which covers him and his wife, told CPP his monthly payment rose from about $1,000 per month to $2,670. By the time he cut his first check of the new year, his stress had turned to resignation, he said.

He and his wife weighed the option of going without insurance, but ultimately decided that it wasn’t a realistic option for them.

“We look at it somewhat as bankruptcy insurance,” he said, in the case that one of them experiences a major health emergency.

The added expense has changed the way Pitts is planning for his future.

“I have had to re-engineer things that I’m doing in terms of how I’m saving for retirement,” he said. “That has had to be reduced somewhat to assist with these increased premiums. So what that potentially does is create a situation where I may have to work longer.”

Pitt’s situation will sound familiar to many North Carolinians who are facing similar insurance premium hikes this year. More than 975,000 people, representing 8.8% of the state’s population, enrolled in an ACA marketplace plan in 2025, according to KFF.

Michael Kimsal, a resident of Franklin County who runs a software consulting business, told CPP that the out-of-pocket cost for his marketplace plan rose from $650 per month to $1690 without the subsidy.

“This is really the limit as to what’s manageable for us,” he said.

Kimsal said the premium increase will force him and his wife to limit their spending this year, including travel to visit family in other parts of the world.

Insurance premium hikes

Pitts and Kimsal are prime examples of the types of people affected by the expiration of the subsidies, according to Natasha Murphy, director of health policy at the left-leaning thinktank Center for American Progress.

The biggest beneficiaries of the enhanced premium tax-credits were middle-income earners, she told CPP. People who are self-employed and retirees who no longer have employer insurance but aren’t yet eligible for Medicare tend to have ACA marketplace plans and could see large spikes in their premiums this year.

“Because the ACA allows plans to rate by geographic location and age, these are individuals who historically were paying thousands of dollars a month for their insurance coverage, and the enhancements help to drop that amount from thousands to hundreds of dollars,” Murphy said.

“And so when we look at the data, we are seeing that it’s often going to be older adults who are seeing those significant premium increases.”

Analysis from the center found that a 62-year-old couple living in Charlotte with an ACA marketplace plan would see their annual premium rise from $7,225 up to $31,446. The annual cost for a family of four in North Carolina earning $129,000 would increase by $11,221. A single parent with one child earning $85,000 would have their premium spike by $9,976.

“These are potentially catastrophic price increases for people,” Murphy said.

“It brings health insurance from being something they could be able to afford to something they absolutely just can’t pay for anymore.”

House backs extension; Senate deal complicated

The situation playing out on Capitol Hill is fluid.

Last week, the House of Representatives passed a “clean” three-year extension of the ACA subsidies, meaning it has no additional policy changes that could cause debate. Seventeen Republicans bucked party leadership and joined Democrats to pass the measure, although none of those GOP votes came from the North Carolina delegation.

Getting legislation through the Senate has proven to be more difficult.

“There doesn’t seem to be much appetite (from the Senate) for passing the clean three-year extension,” Murphy said.

“There continues to be negotiation around different policy tweaks.”

While the dealmaking has largely been done in secret, Murphy said those policy changes offered up include minimum insurance premiums, capping eligibility for higher earners and additional restrictions regarding coverage for abortions.

If a deal does get made, Murphy said health care marketplaces have the infrastructure in place to ensure that insurance premium reductions go into effect this year. That may involve extending open enrollment, which ended Jan. 15, or opening a special enrollment period.

Republican lawmakers have generally balked at the idea of subsidizing the Affordable Care Act, which they blame for driving up health care insurance premiums in the first place.

CPP reached out to U.S. Reps. Chuck Edwards, Brad Knott and Tim Moore for comments on their “nay” votes to extend the ACA subsidies, but none responded.

“Families across Eastern North Carolina and millions more nationwide are having to pay the price for Washington, D.C.’s failure to extend health care subsidies,” Don Davis, a Democrat representing a portion of eastern North Carolina, said in a statement following the vote. “The Senate must follow the House’s lead and extend these subsidies so families can keep affordable coverage. We can fix what’s broken and bring accountability without pulling the rug out from under so many.”

Sen. Thom Tillis, who could end up playing a pivotal role in a potential Senate deal, also did not respond to a request for comment. A spokesperson for Sen. Ted Budd also did not give a statement and deferred to a thread of posts he made on X in October blaming the Affordable Care Act for surging health care costs.

Pitts, who resides in Edwards’s Congressional District, isn’t buying that message.

“The time for taking rigid stances on ideologies around issues such as these has passed,” he said. “There’s a pretty tremendous segment of the population now that’s having to make decisions like myself."

“Do I keep health care insurance or do I wing it? What really needs to happen is for people to, instead of standing on opposite sides of the room and shouting, to somehow find the middle and for everybody to sit down and decide what they’re willing to give up.”

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Lucas Thomae is a staff reporter for Carolina Public Press, focusing on coverage of government accountability and transparency issues. Lucas, who is based in Raleigh, is a graduate of the University of North Carolina at Chapel Hill. Email Lucas at lthomae@carolinapublicpress.org to contact him.