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Residents of Ulster County, including retired nurse Ann Di Amalfi and her husband, are facing sharp increases in their health insurance premiums due to the expiration of Affordable Care Act expansion subsidies on January 1. The Affordable Care Act expanded Medicaid coverage to those earning up to 138% of the federal poverty level, and Premium Tax Credits were made available to citizens earning up to 400% of the federal poverty level during the pandemic. The subsidy expansion, originally part of the American Rescue Plan Act of 2021 and extended by President Biden’s Inflation Reduction Act through 2025, has not been extended in President Trump’s 2026 federal spending plan, leading to fears of more uninsured people and higher costs for hospitals.
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Ulster County Residents Brace for Health Insurance Premium Hikes
As subsidies provided by the Affordable Care Act (ACA) expansion are scheduled to end on January 1st, residents of Ulster County are confronting steep increases in their health insurance premiums. Amongst them are retired registered nurse, Ann Di Amalfi and her self-employed musician husband, Gerano.
“After the cessation of the subsidies, affording Gerano’s insurance becomes impossible. Our premium has hiked from $107 a month to $1,200 a month,” states Di Amalfi. She fears they may have to revert to their pre-ACA strategy of surviving without insurance – a daunting prospect considering Gerano’s pre-existing condition, diabetes.
Before the implementation of the ACA, or Obamacare as it is often called, the United States exercised a system of offering health care insurance via Medicaid to citizens earning equal to or less than a federally defined poverty threshold.
However, the ACA expanded Medicaid coverage to individuals earning up to 138% of the federal poverty level. It also introduced Premium Tax Credits, essentially subsidizing private insurance for those earning above the Medicaid threshold. These individuals could purchase health insurance via a marketplace, such as the “New York State of Health” in New York state.
In response to the COVID-19 pandemic, the program was further expanded in 2021 to offer Premium Tax Credits to citizens earning as much as four times the federal poverty level. This expansion, originally part of the American Rescue Plan Act of 2021 and later extended by President Biden’s Inflation Reduction Act till the end of 2025, has been omitted from President Trump’s 2026 federal spending plan, the One Big Beautiful Bill.
Duncan RyanMann, professor at SUNY Empire University’s College of Business, warns of the effects of an increase in uninsured citizens. “This has implications for not just the uninsured populace but everyone else since it creates a spillover effect. Formerly insured patients who are no longer able to afford treatment will force hospitals to raise prices to offset the cost,” he comments.
Pre-ACA, Gerano relied heavily on walk-in clinics and the emergency room, which lack preventative measures, leading to late detection of his prostate cancer. In 2020, Di Amalfi was able to obtain a policy for Gerano under the expanded tax credits, which covered his treatment at Memorial Sloan Kettering. The threat of his cancer returning before he qualifies for Medicare is a terrifying prospect for them.
RyanMann emphasizes the gravity of such medical costs. “For conditions like cancer, you could be looking at a bill in the region of half a million dollars,” he says. He also notes that the U.S. is the only developed nation without universal health care insurance, despite spending twice per capita compared to other countries while leaving 7-8% of its population uninsured.
Data from the Kaiser Family Foundation shows that a 60-year-old couple in Ulster County earning a combined $82,000 and purchasing the second-lowest cost silver plan can expect their premium to rise by an average of 162%—an increase from $581 to $1,520.
The expiration of the ACA subsidies could push tens of thousands of insured citizens off the insurance rolls, shifting the burden onto hospitals to treat uninsured patients.
Health care insurance broker and partner at Mid-Hudson VIP, Luke Strothenke, warns, “The burden will fall on the consumer. Hospitals will struggle to collect payment from uninsured patients seeking emergency medical service.”
In New York, health insurance providers must obtain approval from the Department of Financial Services to increase premiums. Major providers have all requested significant increases to their small group market premiums. United Health Care rates will rise 6.8 percent, MVP 17.9 percent, and CDPHP 22.1 percent.
Among the hardest hit will be residents like freelance make-up artist, Rhea Carmichael, who relies on the ACA’s Essential Plan and will see her monthly payment increase from $60 to over $500. She suffers from Sjögren’s syndrome, an autoimmune disease, and requires regular medication. “What am I supposed to do? Rob a bank? Die?” Carmichael asks.
The New York insurance exchange State of Health estimates that approximately 450,000 individuals across the state will lose their Essential Plan coverage by July of 2026. With Republicans controlling the Congress, Senate, and the White House, Congressional Democrats’ pleas to extend the tax credits remain unaddressed.
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