For some Plumas County residents, health insurance may be getting more expensive in 2026. Until Dec. 31, 2025, Plumas residents, like 24.2 million other Americans, benefitted from discounts that made health care more affordable. Now, with premium costs spiking nationwide, fears loom over delayed care, higher uninsured rates and strained local health resources.
2026 brings hard decisions about insurance
The 2010 Affordable Care Act — also known as Obamacare — provided “premium tax credits,” which reduced or eliminated monthly out-of-pocket costs for some enrollees based on income. Additional enhanced subsidies were introduced in wake of the COVID-19 pandemic in 2021 through the American Rescue Plan Act, and later extended through the Inflation Reduction Act of 2022. These made coverage more affordable and extended subsidies to a broader range of income groups.
These additional discounts expired on Dec. 31, 2025. With the first of the year, ACA subsidies returned to standards established in the original legislation: Eligibility for premium credits is limited to households earning between 100% and 400% of the federal poverty level, which is set at $15,650 a year for a single person for 2026. Individuals earning above 400% ($62,600) will pay the full premium, which can mean increases of hundreds of dollars a month.
In Plumas County, where the median household income was just under $65,000 in 2023, that could mean difficult decisions about whether to continue carrying health insurance, and when to seek health care in the year ahead.
High premiums or loss of coverage?
Public health officials warn that losing coverage can lead to delayed treatment for conditions like diabetes, heart disease and cancer, potentially raising long-term costs for individuals and the community.
“One of the main concerns is that people continue to have illnesses and injuries regardless of their health insurance status,” said Plumas County Public Health Agency Director Nicole Reinert. “Lack of health insurance may lead to increased emergency room visits due to minimal preventive care.”
Reinert added that the county’s public health infrastructure has been strained since funding shifts under ACA. A sudden rise in uninsured residents could not only increase emergency visits but also incur uncompensated care costs for hospitals.
The increase in uninsured emergency visits can impact the fiscal health of local hospitals. Hospitals will have to absorb the cost of uninsured medical expenses. “Without access to affordable coverage, individuals are less likely to seek preventive care, leading to the development of serious health conditions that are more costly to treat,” said Reinert.
Those who have had extra help will have two choices: face higher premiums or choose to drop coverage entirely.
To respond to these concerns, the county agency is increasing outreach efforts and coordinating with social services, Partnership HealthPlan of California and behavioral health. Caleb Johnson, chief financial officer at Plumas District Hospital, said the hospital does not have direct insight into how often patients previously relied on the enhanced subsidies. Those who have had extra help will have two choices: face higher premiums or choose to drop coverage entirely.
“If they choose to continue with coverage, they pay more out of pocket, but from our perspective, we wouldn’t notice anything different,” Johnson told The Plumas Sun. “But if they decide not to have coverage, that could increase our bad debt.”
Johnson noted the hospital already records some bad debt annually — around $700,000 in the last fiscal year. That’s often because insured patients struggle with deductibles and coinsurance. He expects the subsidy lapse to contribute a “nominal uptick” in bad debt, though it may be hard to isolate from existing trends.
Johnson also expressed concern about patients delaying care. “I would imagine that would occur,” he said. “If premiums increase, patients might shop for lower-cost plans with higher deductibles or skip care altogether to cover groceries and rent. A small problem that could be fixed now at lower cost might become a much bigger, more expensive problem later.”
Seneca Healthcare District, in a statement to The Plumas Sun, said that the hospital is not making assumptions about how the expiration of enhanced federal subsidies will impact their healthcare operations. However, the statement said they are “actively strategizing to prepare for a range of possible scenarios.”
National debate ongoing
A loss of subsidies has a disproportionate impact in rural communities like Plumas County, according to a recent study by the University of California, Berkeley, School of Public Health. Limited access to specialized medical care and emergency services are among the challenges. Others include geographic isolation, transportation, limited access to broadband and clinical workforce shortages, the study found.
Over 22 million Americans who receive health care coverage through the ACA are seeing their monthly premium costs more than double on average, according to the health policy research nonprofit Kaiser Family Foundation. This includes about 1.5 million residents enrolled in Covered California, the state’s marketplace plan. About 400,000 of them are expected to drop out and be uninsured, said Jessica Altman, the state plan’s executive director.
While it does not provide the full picture for the year, data updated Jan. 12 by the Centers for Medicare & Medicaid Services shows that about 1.4 million fewer people nationwide have signed up for ACA plans, compared to the same time last year.
Though the U.S. House of Representatives Jan. 8 voted to extend the enhanced ACA subsidies for another three years, approval by the Senate is by no means certain. Sen. Bernie Moreno, a lead negotiator, has said legislative text is not expected until the last week of January. The open enrollment for 2026 ends Jan. 15 in most states, but has been extended to Jan. 31 in California. Even if the bill does pass the Senate, the president told reporters on Air Force One Jan. 11 that he may veto legislation that would extend enhanced subsidies.
Meanwhile, the future remains unclear for many. Reinert, the Plumas public health director, acknowledged that navigating insurance options can be challenging. The criteria often depend on specific financial and personal details, she said.
“We suggest reaching out directly to the county’s department of social services for specialized support. Their team can offer expert advice to help clarify your eligibility and guide you through the available programs,” said Reinert.
The Plumas County Department of Social Services can be reached at 530-283-6350. Since Covered California open enrollment runs through Jan. 31, residents can still compare plans, check eligibility and enroll at coveredca.com or through certified enrollment counselors.
