ACA subsidies could reshape midterms
By: Nathan Layne
Reuters
BECKLEY, West Virginia - Fro Larry Jackson, a Donald Trump-backing Republican hoping to unseat his party's incumbent in a West Virgina congressional primary next year, [2026] the fight in the U.S. congress over Affordable Care Act subsidies is both personal and political ammunition.
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Jackson, 42, says steep ACA premium hikes facing West Virginians - estimated one think tank to average nearly 400% per enrollee next year [2026] - highlight the stakes of the expiring subsidies. It's an issue he plans to spotlight in a border cost-of-living message for his campaign to keeping them in place.
..... The election of ACA subsidies as an electoral issue among Republicans in one of the nation's most reliably conservative states a year before American go to the polls for midterm congressional elections underscore the issue's potential potency.
..... Jackson, a business owner, has relied on the ACA to provide health insurance for his family of eight. Without the enhanced subsidies, due to expire at the end of December, [2025] his monthly premium is set to quadruple to $1,850 a month.
..... Democrats' refusal to approve discretionary funding for federal agencies until Republicans agree dot extend subsidies triggered the longest government shutdown in U.S. history. It ended on November 12 [2025] without a deal to extend them.
..... Democrats are expected to campaign vigorously on the hikes they seek to break the Republican grip on Congress in next November's [2026] elections.
..... "These tax credits cannot expire. It's going to hurt a lot of people in west Virginia," Jackson told Reuters. "We can all agree there are problems with the Affordable Care Act, but the government needs to extend these credits as they work that out."
..... The subsidies, introduced during the COVID-19 pandemic, expanded federal assistance for Americans seeking helaht insurance through marketplace created by the ACA, also known as Obamacare.
..... with an aging, rural population and some of the nation's highest rates of poverty and chronic illness, the sate of nearly 2 million people faces among the biggest proposed premium increases in the country. the subsidies have provided a crucial lifeline to tens of thousands of West Virginians previous priced out of Obamacare coverage.
..... A deal struck on November 9 [2025] between Republicans and a handful of Democrats in the Senate to end the 43-day shutdown left the fate of the subsidies in limbo. while Senate ;leadership promised a vote on the subsides in December, Republican leaders in the House of Representatives have not committed to a vote on them.
..... Of the more than 30 people Reuters spoke to in West Virgina, a comfortable majority, including all Democrats and several Republicans, supported extending the subsides until, congress could formulate a plan to make health insurance more affordable.
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Republicans who opposed the extension expressed concerns about focal discipline or potential fraud in the program, including one whose business was insuring its employees through Obamacare.
..... Keeping the subsidies would likely receive broad support nationwide, according to a poll conducted by helaht policy organization KFF form October 27 through November 2. [2025] It found three-quarters of adults backed their extension.
..... Simon Header, an associate professor of public health at Ohio State University, said the issue is unlikely to move the needle enough in the midterms in a staunchly Republican state like West Virginia, where Trump won 70% of the vote in the 2024 presidential election. But it could make a difference in s0-called purple states closely divided between the two parties.
..... "It's going to give Democrats something to run on," said Haeder, who has researched the intersection of health policy and politics.
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In an October [2025] Reuters/Ipsos poll, 37% of Americans said Democrats had a better approach to health care, compared with 27% who favored Republicans.
..... Brian Darling, a Republican strategist and former Senate aide, said inflation and the border economy will likely be top of mind for voters next November, [2026 but health care policy could tip close races
..... "Republicans need to have a health reform proposal drafted and ready to deploy in the enhance subsidy debate or they will lose on policy and at the ballot box,: he said.
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The Center for American Progress, a liberal think tank, estimates ACA enrollees in West Virginia face an average 387% increase in their premiums without the subsides, more than any other state.
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According to KFF projections, a 60-year-old couple making $85,000 in the state's first congressional district - represented by Miller - will see premiums jump by 654%, or $602, to $4,540, second only to Wyoming's long district at 693%.
..... Tami White, who works at an insurance agency in West Virgina, said here firm has been renewing lower-income clients in new ACA plans, with premium hikes ranging from 20% to 100% for similar or downgraded plans. It has yet to renew any clients with earnings above 400% of the poverty line due to the cost.
..... While households below the 400% threshold - $84,600 for a couple - will still qualify for a lesser tax credit, those above it will receive nothing if the subsides expire.
..... As many as 15,000 West Virginians are at risk of losing health coverage because they cannot afford the new premiums, according to the West Virginia Center on Budget & Policy, a progressive policy research group, potentially compounding the state's health care problems ahead of planned Trump administration cuts to Medicaid, the government health insurance program for low-income Americans.
..... The reductions are part of the sweeping package of tax and spending cuts Trump singed into law in July. [2025] Once those cuts are fully implemented the state's hospitals, which rely heavily on Medicaid dollars, could lose 41 billion per year, according to West Virginia Hospital Association CEO Jim Kaufman.
..... Miller, who is facing the primary challenge from Jackson and tow other Republicans, did not respond directly to questions on whether she supported extending the tax credits. Republicans could negotiate on the credits once the government reopens, Licolas Gray, a spokesman for Miller, said.