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Photo via Adobe Stock<\/p>\nPhoto via Adobe Stock<\/p>\n
Sharon Poddick is someone who budgets down to the last dollar. When she lost her job in companywide layoffs a little over a year ago \u2014\u00a0and with it, her employer-sponsored health insurance \u2014\u00a0she and her husband started buying health care from Vermont Health Connect, the state\u2019s Affordable Care Act marketplace.<\/p>\n
They started to \u201ctighten everywhere we could tighten\u201d when it came to their budget, as Poddick described it. Her car is paid off; she bought her phone refurbished years ago; she\u2019s whittled down expenses wherever she can.<\/p>\n
So, when she saw that the subsidies that had made their Affordable Care Act health insurance plan affordable would sunset at the end of 2025<\/a>, it was like a \u201ctidal wave coming.\u201d\u00a0\u00a0\u00a0<\/p>\n READ MORE<\/p>\n \t\t\t\t\t\t\t\t \t\t\t\t\t\t\tby Olivia Gieger<\/a> \u201cWe were doing well. We were keeping up, and then this hit us,\u201d she said.\u00a0\u00a0<\/p>\n Sharon and her husband, Kurt, are among the thousands of Vermonters for whom a steep increase in health insurance premiums is now the reality. The close of 2025 brought the end of the enhanced advanced premium tax credit, which made subsidies for Affordable Care Act marketplace plans available to those earning more than 400% of the federal poverty line and increased the amount of credits. The original subsidies \u2014 for those buying marketplace insurance and making less than 400% of the federal poverty line \u2014 remain in place.\u00a0<\/p>\n On Jan. 15, the period for enrolling in health insurance through Vermont Health Connect closed without an extension of those federal subsidies that kept many plans affordable.<\/p>\n The Poddicks waited as long as they could before buying a health insurance plan for 2026 \u2014 holding out some hope that the back-and-forth in Washington<\/a> over whether or not to extend the enhanced premiums could bring some resolution. It didn\u2019t.\u00a0<\/p>\n Sharon Poddick has since found a new job that she loves, working for a local restaurant group, but her employer is too small to subsidize her insurance. Her husband Kurt is self-employed. They are both 55, and with his job as a contractor, they felt like dropping insurance entirely was not an option.<\/p>\n \u201cIt didn\u2019t feel like it was a choice for us. We felt like we had to have some coverage,\u201d Poddick said.<\/p>\n In December they enrolled in the cheapest option available to them: a bronze plan from MVP for $1,700 a month. The deductible is $10,000 for each person.<\/p>\n Just last year they were paying almost half that \u2014 $900\u00a0\u2014 for a gold plan from BlueCross BlueShield of Vermont.<\/p>\n In the first week since enrollment has closed, the state has a first glimpse of how many Vermonters find themselves in a situation like Sharon and Kurt. Early indicators show a health care landscape where many Vermonters may be un- or under-insured.<\/p>\n The numbers of the new landscape\u00a0\u00a0<\/p>\n More than 2,500 Vermonters dropped their plans for 2026, data from the Department of Vermont Health Access shows<\/a> \u2014\u00a0nearly five times the rate of disenrollment the state saw last year.<\/p>\n With the loss of subsidies, Vermont has collectively lost around $72 million in federal support, Addie Strumolo deputy commissioner of the Department of Vermont Health Access, told legislators in a Tuesday briefing<\/a>. Originally the department had estimated<\/a> the state stood to lose $65 million.<\/p>\n Currently, 30,334 people are still enrolled in marketplace plans. Early data from the department shows many cases like the Poddicks\u2019, where people are shifting the types of plans they enrolled in.\u00a0<\/p>\n About one-third of marketplace enrollees opted for bronze plans this year (the least expensive option), an increase of about 4%-5% from last year. Silver plans (which in Vermont are more expensive than gold plans) saw a dip to 13% of the marketplace share, compared to last year\u2019s 21%. This year, 49% of people are in gold plans \u2014 last year, that was 45%.<\/p>\n<\/p>\n Strumolo gave lawmakers this data with the caveat that though enrollment has closed, \u201cit takes a while for this all to settle out.\u201d As people receive their initial bills, she expects more to drop their coverage, she said.\u00a0<\/p>\n The high proportion of gold enrollment is, in part, likely \u201cresidual\u201d from last year, she added, describing the state\u2019s push at the time for people to enroll in the plans recently made less expensive than the silver. However, the trend toward bronze is likely a consequence of the high costs without the extended subsidies, she said.\u00a0<\/p>\n The next step, Strumolo said, is to look at who is dropping their plans to get a better picture of whether Vermonters are underinsured with the plans they now have \u2014\u00a0meaning, that even with insurance coverage people are still unable to cover their costs of their care.<\/p>\n Mike Fisher, the state\u2019s health care advocate, explained this need for more context: \u201cThe question is not actually how many people (enroll) but it\u2019s also about how well they\u2019re sorted,\u201d he told VTDigger.<\/p>\n Not all enrollees are weighted equally in an insurance plan; a good plan relies on healthy people paying more into the pool than they take out in care costs so that people with higher health needs can have their care covered without paying out every single dollar. The health insurance pool is an equalizer, but when healthy, low-cost people leave, it throws off the balance, he said.\u00a0<\/p>\n And, when premium costs go up, those healthy, low-cost people are often the first to leave the pool.\u00a0<\/p>\n \u201cEven a small number of people who have low health care costs leaving the market can have a real impact on the costs for the rest of the market,\u201d Fisher said.\u00a0<\/p>\n The trend creates a vicious cycle of increasing premium costs. Already, insurers predicted a loss of (relatively healthy) enrollees and baked that into their premium increases for 2026. Fisher expects that next year\u2019s premium increases will reflect the reality of the financial hit insurers are taking with how many healthy people drop coverage this year.<\/p>\n \u2018I have insurance, and I can\u2019t afford to use it\u2019<\/p>\n Fisher worries particularly about the population who have lost the subsidies and are now struggling to pay for their premiums with high deductibles \u2014\u00a0people like Sharon and Kurt Poddick.<\/p>\n \u201cThe story I hear that I hate the most is \u2018I have insurance, and I can\u2019t afford to use it,\u2019 and that\u2019s going to happen more,\u201d Fisher said.\u00a0<\/p>\n At the start of the year, the Poddicks canceled all of their upcoming doctors appointments in an effort to save money. Poddick explained she didn\u2019t want to be caught footing the bill for a lab test or other unexpected costs in a regular visit.<\/p>\n \u201cThere\u2019s no annual physical happening; there\u2019s nothing that\u2019s routine. We\u2019ve just cut it out,\u201d she said. \u201cI don\u2019t know if I\u2019m going to be able to pay the doctors when I actually go see them.<\/p>\n \u201cThe only reason we\u2019re buying this insurance right now, (is) if we have a major medical situation. Otherwise, you\u2019re financially ruined, but you\u2019re also kind of financially ruined by paying the premium every month,\u201d she said.<\/p>\n The reality of a state full of people who do not receive primary or preventive care weighs heavy on many health care experts \u2014\u00a0not only because of what it means for the well-being of the individuals who can\u2019t access that care, but also what it means for the financial well-being of Vermont\u2019s health care system.\u00a0<\/p>\n Earlier interventions and routine primary care can keep insurers and hospitals from footing the bill for more expensive, more advanced health needs \u2014\u00a0think of routine skin cancer screenings or colonoscopies compared to the costs of treating a progressed cancer. It\u2019s part of why lawmakers in Montpelier are trying to prioritize primary care<\/a> in proposed legislation this session.<\/p>\n When people do face inevitable health care emergencies, they often land in a hospital\u2019s emergency room, regardless of if they have insurance. Hospitals end up bearing the costs when treating patients unable to pay for care.\u00a0<\/p>\n
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\n\t\t\t\t\t\tOctober 31, 2025, 5:26 pmNovember 3, 2025, 4:39 pm\t\t\t\t<\/p>\n