Heather Altman, at her Long Beach home on July 11, 2025, worries she won’t be able to afford health insurance under the newly approved GOP budget bill. Photo by Jules Hotz for CalMatters
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Heather Altman quit her corporate job and opened an environmental consulting business in 2014 when the Affordable Care Act made it possible for her to afford independent health insurance. Her monthly premium for a platinum plan was $356.
Today, Altman has downgraded to a gold plan and pays $1,147 per month. That’s a 222% increase over the past decade for less comprehensive coverage. Medical inflation has always outpaced general inflation, but early analyses project premiums will increase even more dramatically as a result of the reconciliation budget recently signed by President Donald Trump, and Altman is worried she won’t be able to pay for health insurance any longer.
“Since the Senate passed this monstrosity I’ve been trying to figure out how I can land on my feet,” Altman said.
Altman is one of nearly 2 million people in California who rely on the Affordable Care Act marketplace, commonly known as Obamacare or Covered California. Many own their own businesses like Altman or work for small employers that don’t provide insurance.
The majority of enrollees are lower- to middle-income earners making $60,240 or less as individuals or $124,800 or less as a family of four. Nearly 800,000 people in California make half that amount.
Trump’s budget bill made significant changes to Covered California that experts and insurers say will increase out-of-pocket costs for consumers. This includes more complicated enrollment and verification procedures; eliminating automatic re-enrollment; prohibiting people who sign up outside the end-of-year open enrollment period from qualifying for financial assistance; prohibiting certain immigrant groups – including legal refugees – from receiving financial assistance; and requiring people who inaccurately predict their income to repay all subsidies received, a change from when previous repayments were capped based on income.
The biggest hit to consumers came by omission: Trump’s budget bill did not extend enhanced subsidies, which will expire at the end of this year. Those subsidies were enacted during the COVID-19 pandemic to ensure more Americans could afford health insurance. As a result, premiums fell for all income levels and enrollment doubled nationwide from 12 million to 24 million people between 2021 and 2025.
In California, nearly 90% of enrollees receive federal subsidies.
Some of these changes, including the expiration of subsidies, will go into effect next year, which means consumers will see higher prices as soon as November when open enrollment starts. Other changes, such as who can enroll and when, will start in 2028.
Cost will rise significantly
In California on average, premiums are expected to increase by 66%, or $101, per month starting next year without subsidies, according to projections from Covered California. Lower-income people will see even higher increases because they receive more subsidies.
Those making less than 400% of the federal poverty level (about $60,240 per year for an individual) are projected to pay an average of $191 more monthly, according to Covered California data.
More than 170,000 middle-income enrollees will lose financial assistance entirely. Some federal subsidies will still be available, but they are less comprehensive than the enhanced subsidies, and fewer people qualify.
Altman said even without any changes to the Affordable Care Act marketplace, the regular annual premium increases are “almost unsustainable.” Most years, she makes too much money to qualify for subsidies, but health care costs are still a drain on her finances.
On average over the past decade, Altman’s premiums have increased by more than 11% annually, according to data she shared with CalMatters. In comparison, the Consumer Price Index, a measure of inflation, increased an average of 2.7% annually during the same time period, according to U.S. Bureau of Labor Statistics data.
Heather Altman works at her desk, inside her home office in Long Beach on July 11, 2025. Photo by Jules Hotz for CalMatters
“If this is what I knew the situation would be when I started my business, I never would have done it,” Altman said. About one in four Covered California enrollees is self-employed. Altman is contemplating asking a colleague to hire her without salary just for the benefits, she said.
That type of thinking is common right now, said Janae Trevillion, a long-time human resources consultant who works with small businesses. She said some of her clients, like Altman, are trying to get corporate jobs just for the benefits.
“There’s a lot of movement happening,” Trevillion said.
600,000 could drop Covered California
The enrollment changes that will take effect in 2028 will also cause people to get rid of their Covered California insurance, Trevillion said. As the paperwork and verification processes get more complicated, fewer people will be willing to go through the sign up process, she said.
“People get frustrated easily,” Trevillion said. “People are going to say ‘I’m not interested,’ and people are not going to want to participate in having a marketplace plan.”
Between added enrollment complexities and higher out-of-pocket costs, Covered California estimates that 600,000 Californians will drop their insurance.
“We have tried for our entire existence to make the process easier, to minimize administrative barriers, to simplify … to remove this friction from the system,” said Covered California Executive Director Jessica Altman, who is not related to Heather Altman. “We know that it matters, and so anything that goes the other way is going to result in less people covered.”
About 70% of Covered California enrollees are automatically re-enrolled each year, a process that will end under the new policies implemented by Trump’s budget reconciliation.
As more people drop out, costs will increase even further, said Edwin Park, a research professor at Georgetown University and a leading expert on Affordable Care Act expansions.
“Any time you have big reductions in enrollment, the ones who are most likely to be disenrolled … are the healthiest, lowest cost people, so that means a sicker risk pool, which in turn means higher premiums for those inside the marketplace,” Park said.
In recent years, California has consistently had one of the lowest-risk insurance pools in the country because Covered California has successfully attracted younger and healthier people to sign up for insurance, Jessica Altman said.
The Congressional Budget Office estimates that premiums for Affordable Care Act benchmark silver plans, the second-to-lowest-cost silver plan in each state, will increase by an additional 7.9% as risk pools become sicker.
Many of us could be leaving this important task too late
Holidaymakers must ensure they follow this step when planning trips or risk losing out(Image: Getty)
Financial expert Martin Lewis has advised Brits not to overlook a crucial step when arranging their holidays. And he said missing this from your list before a holiday could even result in you losing thousands of pounds.
Martin Lewis, through his Money Saving Expert website, has cautioned that travellers must arrange travel insurance immediately upon making their booking. Delaying this essential step could leave you in financial difficulty should problems arise before departure.
MSE began by stating: “Booked but not got travel insurance yet? Do it now! Martin’s been yelling ‘get travel insurance ASAB’ (As Soon As you Book) for years.
“Yet still too many excitedly book their holiday, then leave insurance till the last minute. That’s a mistake – half the cover’s value is protecting you before you go, in case something stops you going. So if you’ve booked and not got cover, do it right now!”
Drawing from personal encounters, Martin said: “Every year, a few people contact me after something awful, such as a cancer diagnosis that needs chemo, but the airline or hotel won’t refund them (they don’t have to). I tell them: ‘That’s what insurance is for, speak to your insurer.’
“But if they haven’t got it yet, no matter how horrid the circumstances, there’s nothing that can be done. Don’t be that person.”
Martin Lewis said people should ‘get travel insurance as soon as you book’(Image: Getty)
Where to obtain travel insurance
MSE specialists have highlighted some of the most cost-effective travel insurance alternatives that hold Financial Conduct Authority regulation. For those travelling overseas twice annually or more, they suggest securing an annual policy.
MSE advised: “If you’ll go abroad at least twice a year, even just for weekends, annual cover usually works out cheapest. It covers virtually all trips away, though often has a duration limit of a max 30 days per trip (you can oft pay more to extend this). The exact price depends on age and circumstances, so we give the four cheapest options – check at least a couple.”
For those under age 66 they recommended checking policies from:
Coverwise
Admiral (use discount code MSE15)
Leisure Guard Flexi
Urban Jungle
For over-65s they recommended:
Admiral (use discount code MSE15)
Urban Jungle
Leisure Guard Flexi
Saga
If you’re only going away once in a year it’s probably best to get single-trip insurance. “For those who just want to cover one trip (or may need specialist cover for it), enter the dates you’re travelling, even if months ahead, and you’ll be covered for cancellation from the moment you pay,” MSE said.
For those under age 66 they recommended looking at:
Coverwise
A to Z Insurance
Admiral (use discount code MSE15)
Leisure Guard Flexi
For over-65s they recommended:
A to Z Insurance
Admiral (use discount code MSE15)
Leisure Guard Flexi
Coverwise
You must remember that if you have, or have ever had, a physical or mental health condition, you’ll usually need to declare it to the travel insurer. In some cases, it changes nothing.
To compare travel insurance options you can use the MSE cheap travel insurance finder tool here.
July 24 2025, 9:32 am | BY Ricki Green | No Comments
Following a competitive pitch for media, Southern Cross Travel Insurance (SCTI) has finalised its agency village, with three Sydney-based agencies to lead its advertising, PR and media strategy across Australia and New Zealand, marking a significant step in its trans-Tasman growth ambitions.
Creative duties in Australia will be handled by strategic marketing agency Quantum Jump Sydney, a NZ-founded agency which recently expanded to Australia, known for its award-winning work in data-driven creative, CRM and loyalty.
The media account was won by This is Flow across both Australia and New Zealand markets. The Sydney-based independent agency, celebrated for its culture, innovative planning tools and results-driven approach, will lead all media planning and buying activity from traditional through to performance.
Sydney-based PR and communications agency Sedgwick Communications has continued its longstanding partnership with the travel insurer and retained its Australian PR account – a testament to the agency’s deep understanding of the SCTI brand, proven track record, and commitment to delivering outstanding communications.
Says Jess Strange, Chief Customer Officer at SCTI: “We’re excited to announce our new agency village and our partnerships with This Is Flow, Quantum Jump Sydney and Sedgwick Communications, particularly as we accelerate our growth in the Australian market. All our agencies bring deep digital expertise and a strong focus on performance, which aligns perfectly with our customer-first philosophy.
“We loved Flow’s transparent, real time media approach, QJ’s collaborative approach to creative ideation, and their focus on our success. Both agencies’ Kiwi connections are a bonus, but it’s their understanding of the Australian landscape that makes them ideal partners for this next chapter”.
Says Jimmy Hyett, CEO of This Is Flow: “SCTI is the kind of brand we love to work with – ambitious, customer-centric and ready to push boundaries. Our mission is all about delivering a state of growth for our clients, and with SCTI, we have a chance to bring this to life across both countries, creating work that not only performs, but genuinely connects with travellers.”
Says Rachel Wintle, GM for Quantum Jump Sydney: “Quantum Jump is built on heavy-duty thinking and creative magic. Our expertise in driving return on customer has delivered real commercial impact in New Zealand, and we’re thrilled to partner with This is Flow and Sedgwick Communications to support SCTI in Australia. SCTI is a brand with purpose and ambition – we’re proud to be part of the journey and excited to grow the brand in Australia.”
Says Laura Sedgwick, Managing Director at Sedgwick Communications: “We’re proud of the depth of our partnership with SCTI, built over years of working closely together to grow the brand. As SCTI continues to pursue ambitious growth plans, we’re excited to help drive that journey, delivering sharp, strategic communications that connect with travellers and support the business at every step.”
With the new agency village now onboard, SCTI is poised to deepen its engagement with Australian travellers while continuing to lead in New Zealand. The appointments signal a new era of creativity, strategy and impact for the trusted Kiwi travel insurer.
Pictured (L-R): Ben Goodale (Quantum Jump); Jess Strange (Southern Cross Travel Insurance); Laura Sedgwick (Sedgwick Communications); Rachel Winkle (Quantum Jump); Jimmy Hyett (This Is Flow)
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For the millions of Texans who get their health insurance on the marketplace, coverage is likely to get a lot pricier next year.
In 2026, marketplace enrollees will likely face a dual hit, from the expected expiration of federal subsidies and insurers’ forecasts of higher premiums.
Texas already has the highest uninsured rate in the country, and higher marketplace costs could push more people to forego coverage.
“Most enrollees are going to be facing a double whammy of both higher insurance bills … but also the loss of the subsidies that lower much of that cost to them,” said Matt McGough, a policy analyst at KFF.
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Marketplace plans are the health coverage options that people can purchase for themselves and their families under the Affordable Care Act. Nearly 4 million Texans enrolled in such plans for this year.
Expiration of subsidies
The larger cost hit is likely to come from a change in federal policy.
Many marketplace enrollees are currently eligible for enhanced federal subsidies to help pay for their marketplace plans. The enhanced subsidies, which give more funding to low-income enrollees and also expand eligibility to more middle-income enrollees, were originally added in 2021.
However, the enhanced subsidies expire at the end of the year, and U.S. lawmakers have not moved to renew them. If they expire, marketplace enrollees would have to pay their existing premiums plus any cost previously covered by the federal government.
For Texans receiving subsidies for marketplace plans, removing enhanced funding would lead to the average premium payment more than doubling.
For those Texans, according to KFF, the average annual premium in 2024 was just shy of $400. Without enhanced subsidies, the annual premium cost would be about $850.
Tom Banning, the CEO of the Texas Academy of Family Physicians, said in an email that the federal subsidies have so far protected Texans from the rising price of individual health insurance.
“But with those credits set to expire at the end of 2025,” Banning wrote, “Texans who buy their own coverage … are about to get financially crushed.”
Rising premiums
The anticipated expiration of the subsidies is also part of the calculation for marketplace insurers themselves.
Marketplace insurers are requesting the largest premium increases since 2018. That’s according to an analysis posted last week by the Peterson Center on Healthcare and KFF, which pulled data from 19 states, including Texas, plus Washington, D.C.
Across the available data, which is preliminary and subject to change, the 2026 premiums are forecast to increase by a median 15%. Blue Cross and Blue Shield of Texas proposed a rate increase of 21%, according to McGough at KFF.
The projected increases are partly an indication of insurers’ uncertainty, McGough said, as they face federal changes they’ve never dealt with before.
To explain the anticipated rate increases, individual insurers pointed to factors such as rising health care costs, including the added costs of GLP-1s, and tariffs.
But the expiration of the enhanced federal subsidies will make a significant dent, too. Insurers predict that enrollees who skew healthier may drop their plans if the subsidies expire — meaning the insurers would then raise premiums for the remaining enrollees.
Banning said in an email that enough dropouts could trigger a “death spiral” for marketplace insurance, with ever-rising prices leading to ever-increasing dropouts.
Low-income Texans would be especially hard-hit by subsidies expiring and premiums increasing. If Texans do forego marketplace coverage as a result, they may join the ranks of the uninsured, who are more likely to delay medical care and more likely to die from health issues.
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