Self-employed piano and voice teacher Alice Goldberg of Cheverly, Maryland, was paying only $28 a month for health insurance last year thanks to a combination of state and federal subsidies that covered a significant portion of her costs.
But now Goldberg’s federal subsidy has gone away, leaving her with a monthly bill of $248 — nearly nine times that of what it was before.
This increase has already prompted the music instructor, who has been giving private lessons for almost four years, to reluctantly raise the rates on some of her students. Her plans to buy her first home have also stalled.
“I have to take all of that expendable income that I have in my mind and put it toward this health care stuff,” she said.
Goldberg is just one of millions of Affordable Care Act enrollees struggling after the federal government allowed its special enhanced tax credits to expire at the end of 2025.
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Even in Maryland, where lawmakers implemented a replacement subsidy program to temporarily offset losses for many ACA recipients, many people are paying dramatically more for health insurance. According to the Maryland Health Benefit Exchange, the average person under age 30 who got insurance on the exchange paid a monthly premium of $559 in April – up 46% in a year.
As a result, people are beginning to rethink their health insurance plans and how they spend their money.
Goldberg herself receives money from the state, but only $170 a month. She lost over half of her aid when the federal subsidies expired.
“And I’m telling you, there are people who are so much worse off than I am,” she said.
The subsidies expire
The federal subsidies that expired at the end of last year, formally called Advanced Premium Tax Credits, originated from the Covid-era as an extension of the 2010 Affordable Care Act.
First passed in 2021 and later extended through 2025 as part of the Inflation Reduction Act, these tax credits aimed to offer additional financial support to those already enrolled in the ACA marketplace. They covered a larger portion of people’s health care premiums and expanded to include more middle-income families.
The health policy research non-profit Kaiser Family Foundation found that by 2025, 22 million Americans — over 90% of all ACA marketplace enrollees — were receiving some degree of Advanced Premium Tax Credits.
The federal subsidies had positive effects all across Maryland, said Vincent DeMarco, president of Maryland Healthcare for All.
Roughly 400,000 Marylanders acquired health insurance after the subsidies went into effect, which helped contribute to a $460 million reduction in uncompensated hospital care that would have otherwise been added to insurance costs for everyone, DeMarco said.
Despite these widespread benefits, Congress did not vote to extend the Advanced Premium Tax Credits past their 2025 expiration date, leaving millions of Americans to grapple with pre-pandemic prices.
“One of the hardest things to see happen [was] how abruptly everything was going to change,” said Mika Hamer, an assistant professor at the University of Maryland’s School of Public Health. “Just because you know the cost of your health insurance is changing … it doesn’t change the fact that people need continuous health care.”
The impact in Maryland
In an effort to make that transition a little less abrupt, some states, including Maryland, have adopted differing measures to support those impacted by the loss of enhanced federal tax credits.
Maryland lawmakers approved a state subsidy program in September 2025 that fully replaces federal subsidies for people below 200% of the federal poverty level and partially for those between 250% and 400% of the federal poverty level.
Those above 400% will not receive any relief from the state and are likely to be most impacted by the expiration of the advanced tax credits, the Maryland Insurance Administration said in September.
Baltimore resident and ACA enrollee Bobby Laughlin said his health insurance plan has not changed much this year despite the loss of federal aid because state subsidies have so far made up the difference.
Last year, the 32-year-old restaurant worker and HVAC service technician was down to paying less than $65 a month for his insurance. He would now be paying as much as $450 if it weren’t for the assistance he receives from the state.
Instead, his monthly bill has only increased about $5 since the expiration of enhanced federal subsidies.
“That’s really something I’m thankful for, that in this state, the governor made sure that they were going to continue to fund these credits for health care,” Laughlin said.
But Maryland’s ability to finance the backup program has its limits. Currently, coverage only runs until the end of the year.
Laughlin is aware of this, which is why he is in the process of searching for a new job that offers health insurance.
“I’ll either have to go back to a plan that doesn’t really cover much, which I don’t want to do, [or] I’m gonna have to change my career,” he said.
Goldberg, who is already facing steeper health care costs after losing the federal portion of her tax credits, would be impacted even more if state subsidies ran out. Like Laughlin, she said her bill would increase to about $450 a month.
“That is a lot of money,” she said. “I would be incapable of maintaining a comfortable standard of living.”
What’s happening elsewhere
Not all states have a support system to help cushion the blow of higher insurance costs like Maryland does, said Francesca Weaks, an assistant research scientist who specializes in health equity and environmental justice at UMD’s School of Public Health.
Impacts in southern states have been especially heavy, as some people are trying to decide if they want to keep their health insurance at all, she said.
Experts agree that if health insurance costs for ACA marketplace enrollees continue to rise as a result of expired federal subsidies, then the effects will ripple outward to hospitals, medical care providers and the rest of Americans.
First, as plans become less affordable for ACA participants, they may begin to forego insurance altogether, Hamer said. That could then make them hesitant to visit the doctor and seek early treatment for medical issues.
As a result, hospitals could see an influx of uninsured people in need of serious care, she explained.
Uncompensated care programs exist in Maryland and elsewhere that require hospitals to cover a portion of a person’s medical bill if they cannot afford the cost themselves.
However, if hospitals put more money toward those programs, then they can’t invest in other things like workforce development, new technology and building expansion, Hamer said.
According to DeMarco, the price of more uncompensated care also flows directly into and increases health insurance premiums for everyone.
That is why, he said, “the public needs to know that expanding health care coverage is good for everybody.”
Congress does nothing
It seems unlikely that Congress will revisit the issue of enhanced ACA subsidies anytime soon.
The U.S. House of Representatives passed legislation extending tax credits back in January, but no further moves have been made to address the bill in the Senate, where similar efforts have already been shut down in the past.
Underscoring this lack of attention is the omission of a detailed Affordable Care Act alternative in President Donald Trump’s “Great Healthcare Plan,” a proposal containing new cost-cutting initiatives for healthcare announced in January.
The plan, which is still in its early stages and has yet to advance through Congress, acts as a vague framework for lowering drug prices and insurance premiums. It also vows to make healthcare more transparent by holding big insurance companies accountable for posting their prices.
President Trump previously ran for office on a promise to somehow replace the ACA but has yet to provide any further details, in the plan or elsewhere.
That leaves things up to state and local-level action, at least for now.
DeMarco said it is important to fight for additional resources and “protect what we [already] have,” in terms of affordable care in Maryland, meaning Medicaid. His advocacy group, Maryland Healthcare for All, is currently focused on getting more state funding for the program.
On another note, Maryland residents are taking matters into their own hands to fight for the protection of affordable care.
Hamer said she’s seen churches and other community-based organizations participating in what she called “health insurance co-ops,” pooling their funds together for people use if they need health coverage.
“They’re sort of taking that money out of the market itself and creating their own little market,” she said.
Goldberg has also been doing advocacy work, finding time in between her music lessons to contact local leaders, attend political events and organize protests.
The first thing she did after finding out that enhanced federal ACA subsidies would be expiring at the beginning of the year was call the offices of all of the Republican leaders in the House and the Senate.
“I got mad,” she said. “I told the interns to quit their jobs.”
Then, she contacted 4th District Rep. Glenn Ivey’s office, looking for ways she could get involved.
She has since shared her story in various places: on a private phone call with Ivey and two other Maryland constituents, set up by members of the congressman’s staff, as well as in a speech delivered at the People’s State of the Union rally in February.
Ever the musician, Goldberg even likes to accompany her words with a bit of song.
“One of the best ways I’ve found to create hope is to sing,” she said in her People’s State of the Union address.
The piano and voice teacher is proud of the life and reputation she has built for herself. Although she has to work really hard for her income, she loves her job, she said.
But, she added, having a health care plan is also important to adequately cover things such as accidents, sickness and mental health.
“Its a smart thing to do, it’s like a security thing for your body,” she said. “I need these plans to help me stay stable enough to do my job.”
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