"I'm Terrified I'll Die": Americans Speak Out About Republican Health Care Cuts PDF Free Download
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United States Senate
HEALTH, EDUCATION, LABOR AND PENSIONS COMMITTEE
Bernard Sanders, Ranking Member
Minority Staff Report
October 7, 2025
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“I’m Terrified I’ll Die”: Americans Speak Out About Republican Health
Care Cuts
I. Foreword
Today, we have a health care system that is broken, dysfunctional, and horrifically cruel. Over 85
million people are uninsured or underinsured. We pay twice as much for health care per person
than virtually every major country in the world. Despite spending over $14,500 per capita on health
care, we have a massive shortage of doctors, nurses, dentists, mental health counselors and
pharmacists. Our life expectancy is, on average, four years lower than other wealthy countries and
the average working class American can expect to die seven years younger than the top 1% in our
country.
In my view, we have to do what every other major country on earth has done, and guarantee health
care as a human right through a Medicare for All, single-payer system.
But in the midst of all of this, Trump and his Republican colleagues are doing exactly the opposite.
They are making a horrific situation even worse by pushing our health care system to the verge of
collapse.
Starting this month, millions of Americans are going to get a letter from their insurance companies
telling them that their premiums will double, on average. Unless we reverse course, the Republican
budget will throw 15 million Americans off of Medicaid and the Affordable Care Act. A study
from the Yale School of Public Health and the University of Pennsylvania has estimated that that
these disastrous policies will cause over 50,000 people to die unnecessarily every single year.
Further, Republican health care cuts will cause hundreds of nursing homes, rural hospitals, and
community health centers to shut down or substantially reduce the services they provide.
Last week, I asked people across the country what these cuts would mean for them. What would a
doubling of health care premiums look like? What would it mean if they were one of the 15 million
Americans thrown off their health care? What would it mean if the hospital near them shut down
because of the massive cuts to Medicaid?
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In less than a week, I received hundreds of responses from 42 states and the District of Columbia.
Here is just some of what they said:
• People are afraid they could get sicker or even die. Laura from Wisconsin said, “I live
in fear of whether or not I will be able to afford my life saving treatment. I have a rare
kidney disease that requires immunotherapy every 9 months. I’m terrified I’ll die.”
• People will not be able to afford food, housing and health care. Brittanie from Utah
said, “I'm already living paycheck to paycheck. I have insurance for myself and my two
sons. Just bought a house that we can barely afford.” Sebastian from Colorado said, “I don't
make enough to afford rent and food and health insurance. Only 2 of those things do I need
to survive. These cuts make it even more impossible to turn things around and get a handle
on health issues.” Cara from Vermont said she “was shocked by the warning about the loss
of the advanced federal subsidy. Rather than a premium of $100/month, I could be paying
more than $1,200/month or 35% of my income, and that’s before deductibles and copays.”
• Small business owners are concerned they will have to shut down. Joe from
Pennsylvania said, “I am a small business owner and if my health care costs continue to
rise, I will be forced to close my business and look for a job if I can find one.”
• People living in rural areas do not know where they will go if their hospital closes its
doors. Patricia from California said, “If our local clinics and hospitals close, as they are
likely to with federal funding disappearing along with health insurance becoming
unaffordable, people will die.”
This report also examines how much insurance premiums could increase for the 24 million
Americans who buy their own health insurance. Findings include:
• Premiums are going to double, on average. For many people buying their own insurance,
it will be even worse. For example, according to the Kaiser Family Foundation, in Maine,
a 48-year-old living in Portland earning just $35,000 per year will see their premiums
increase $132 per month, from $86 to $218 per month. In Alaska, a 62-year-old living in
Juneau and earning $50,000 will see their monthly premium increase $183, from $176 to
$359 per month.
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Figure 1: Average ACA Premium Payments Will Double from 2025 to 2026
• Americans are already starting to hear about soaring premiums. The 24 million
Americans who buy their own health insurance will all be able to see how much their
premium will increase on November 1—or 25 days from now. But some states have started
sending notices and opening up their websites. The increases are outrageous.
Figure 2: Examples of Premium Increases in Virginia, New York and Georgia
$888
$1,904
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
2025 2026
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In my home state of Vermont, up to 45,000 people are expected to lose health insurance and over
30,000 people who buy their own insurance are projected to see their premiums more than double.
Vermont is not alone.
This report finds that, unless we reverse course, health care premiums will double, on average, for
over 20 million Americans. Further, the Congressional Budget Office has estimated that 15 million
Americans will lose their health care as a result of these horrific budget cuts. The uninsured rate
will substantially increase in states across the country. No. I will not vote for a Republican budget
that causes premiums to double, 15 million to lose their health care and 50,000 people to die each
year. Democrats, Republicans and Independents must come together and pass a budget that
protects the health care of all Americans.
Bernie Sanders (I-VT)
Ranking Member
U.S. Senate Health, Education, Labor, and Pensions Committee
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II. Trump and Congressional Republicans’ Health Care Cuts
Since taking office, Trump and Republicans in Congress have pushed our broken health care
system to the verge of collapse. They have made cuts to the health care system that will:
• Kick 15 million Americans off the health care that they have;
• More than double premiums, on average, for over 20 million Americans;
• Force health care providers, like community health centers, rural hospitals, and nursing
homes to close their doors;
• Add an estimated 15 million hours in wasted time on paperwork for Americans and state
agencies to navigate bureaucratic red tape;1 and
• Increase potential out-of-pocket costs by up to $900 for hundreds of millions of Americans
with employer-sponsored insurance if they have a serious illness.2
Trump’s One Big Beautiful Bill
Trump signed over $1 trillion in cuts to Medicaid and the Affordable Care Act into law. The “One
Big Beautiful Bill” Act will kick 15 million Americans off health insurance. State governments
will be forced to cut eligibility, cut benefits, or cut payment rates to providers for Medicaid. As a
result, researchers at the University of North Carolina project that over 300 rural hospitals are at
risk of closure.3 Over one in four nursing homes report that they could be forced to close their
doors.4 In addition, millions of Americans could be cut off from primary care if community health
centers are forced to close. Thousands of community health centers are already on precarious
financial footing and stand to lose an additional $32 billion in revenue over the five-year period
after the Medicaid cuts from the Republican budget are enacted.5 Republicans also refused to
extend critical premium tax credits for Americans who buy their own insurance even though they
gave the top 1% a trillion dollar tax cut and also handed out over $900 billion in tax breaks to large
1 Senator Mark Warner. “Democrats Introduce CRA Resolution to Overturn Harmful ACA Marketplace Rule.”
(2025). https://www.warner.senate.gov/public/index.cfm/pressreleases?id=957E7355-DF76-42CF-9B11-
AF094FDA2745
2 Gideon Lukens and Elizabeth Zhang. “Administration’s ACA Marketplace Rule Will Raise Health Care Costs for
Millions of Families.” Center on Budget and Policy Priorities (2025).
https://www.cbpp.org/research/health/administrations-aca-marketplace-rule-will-raise-health-care-costs-for-
millions-of
3 Grace Hayba. “UNC data finds ‘One Big Beautiful Bill Act’ puts 300-plus rural hospitals at risk of closure.”
WRAL (2025). https://www.wral.com/lifestyle/health/nc-rural-hospitals-risk-closure-one-big-beautiful-bill-act-june-
2025/
4 “2025 Provider Insights: Medicaid.” American Health Care Association (2025). https://www.ahcancal.org/News-
and-Communications/Fact-Sheets/FactSheets/AHCA-2025-Provider-Insights-Report-Medicaid.pdf
5 “Reconciliation Bill Jeopardizes Care for Millions.” National Association of Community Health Centers (2025).
https://www.nachc.org/reconciliation-bill-jeopardizes-care-for-millions/. Rosenbaum, et al. “Nearly 5.6 Million
Community Health Center Patients Could Lose Medicaid Coverage Under New Work Requirements, with Revenue
Losses Up to $32 Billion.” The Commonwealth Fund (2025).
https://www.commonwealthfund.org/blog/2025/community-health-center-patients-medicaid-coverage-work-
requirements
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corporations. As a result, while billionaires become even richer, private insurance premiums for
over 20 million people are expected to double next year, on average.
Figure 3: Average ACA Premium Payments Will Double from 2025 to 20266
While Republicans claim that they are revitalizing rural communities through a $50 billion “Rural
Health Transformation Fund,” the Big Beautiful Bill makes nearly $150 billion in cuts to rural
health care through the Medicaid provisions.7
Affordable Care Act Marketplace Rule
The Trump administration also quietly pushed through a new rule allowing private insurers to stick
people who buy their own insurance with higher deductibles, in addition to raising out-of-pocket
costs for everyone with private coverage, including the over 160 million Americans with
employer-sponsored insurance.8 The rule also adds red tape to signing up for coverage, requiring
consumers to submit extra paperwork and documentation to sign up for coverage.
III. The American People Do Not Want Health Care Cuts
On October 2, Senator Bernie Sanders (I-Vt.), Ranking Member of the Senate Committee on
Health, Education, Labor, and Pensions (HELP) asked Americans to share the impact of
Republican health care cuts on their lives.
6 Adapted from KFF. See: https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-would-
more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/
7 KFF, https://www.kff.org/medicaid/how-might-federal-medicaid-cuts-in-the-enacted-reconciliation-package-
affect-rural-areas/.
8 This regulation published at 90 F.R. 27074 allows insurers to sell coverage with lower actuarial values on the
individual market and increase maximum out-of-pocket limits, including for the hundreds of millions of Americans
with employer-sponsored insurance.
$888
$1,904
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
2025 2026
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Hundreds of people responded from 42 states and the District of Columbia sharing their serious
concerns.
People are afraid of getting sicker or even dying.
Scientists at the Yale School of Public Health and the Leonard Davis Institute of Health
Economics at the University of Pennsylvania recently found that Republican health care cuts will
lead to 51,000 additional deaths every year.9 Losing health insurance also makes people sicker,
as they are unable to treat underlying conditions. Yale researchers found that the coverage losses
caused by Republican cuts will lead to “substantial increases in uncontrolled chronic conditions”
annually, including:
• 138,851 additional cases of uncontrolled diabetes;
• 165,165 cases of uncontrolled hypertension;
• and 46,200 cases of uncontrolled high cholesterol.10
Table 1: People are afraid of getting sicker or even dying
Response
State
Name
I live in fear of whether or not I will be able to afford my life saving
treatment. I have a rare kidney disease that requires immunotherapy
every 9 months. I’m terrified I’ll die.
Wisconsin
Laura
If my health insurance costs go up, I won't be able to have health
insurance at all. I'm a widow with 3 children and I work 48 hours
per week. I suffer from migraines, and my health insurance was
covering the $1040 per month cost for medication. I won't be able
to get my medication any longer and will suffer.
Florida
Hayat
My husband and I own a small business in Texas. My husband and
I are on the ACA. I have Lung Cancer. I will lose my coverage due
to the increase as it is already [and] has high premiums. I will die
without healthcare and so will many others.
Texas
Bobbi
I have Asthma and High Blood Pressure, if I lose my health
insurance credit, I won't be able to afford a healthcare plan next
year. Leaving me the only option of saving money with my full-
time $16 an hour job and going to the doctor for refills once or
twice a year. Thankfully my medication is cheap, but if I get very
sick I or have a medical emergency I'll be completely on my own.
Florida
Seth
I will literally die. I already struggle to afford my (poor) healthcare.
This will mean I will literally die.
Connecticut
Katy
My wife and I are in our early 30's. My wife, unfortunately, has
stage four appendix cancer. It's a one in a million cancer that is
continually being learned about…With the added woe of insurance,
I fear our premiums will increase when we already struggle with
managing her life lengthening care.
Idaho
Justin
9 Proposed Changes to Medicaid, other health programs could lead to over 51,000 preventable deaths, researchers
warn.” Yale School of Public Health. (2025). https://ysph.yale.edu/news-article/proposed-federal-budget-could-lead-
to-over-51000-preventable-deaths-researchers-warn-in-letter-to-senate-leaders/
10 Pandey et al. “Quantifying the Mortality and Morbidity Impact of Medicaid Retractions.” MedRxiv (2025).
https://www.medrxiv.org/content/10.1101/2025.05.19.25327564v1.full
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We cannot afford health insurance. My husband is insulin
dependent with multiple health conditions. Things are going to go
downhill very quickly for him.
Kentucky
Michelle
I have to get a second job to afford it because my adult daughter has
a genetic illness with chronic pain now and can't work full time.
She needs a lot of specialists and not all the tests and treatments are
covered to start with.
Florida
Diane
We struggle so much financially but yet make too much to receive
any type of snap [Supplemental Nutrition Assistance Program] or
other government benefits. I have medication for my ulcerative
colitis that cost $8,000 without insurance and even with insurance
it’s $1,500 and only way I’m able to afford it is due to a copay
assistance from the company itself. My daughter has braces,
glasses, ADHD, and asthma, and my son also has asthma and I’m
so worried if insurance becomes so unaffordable myself and my
husband will have to suffer for the sake of my children’s well
being.
Texas
Khorie
People will not be able to afford food, housing and health care
Americans are already beginning to receive notices about skyrocketing health care costs next
year. Without enhanced premium tax credits, premiums for over 20 million Americans will more
than double (114%), on average, next year.11 For many Americans, these cost increases will
force them to choose between paying health insurance premiums and medical bills on the one
hand, and grocery bills and rent on the other.
Table 2: People will not be able to afford food, housing and health care
Response
State
Name
I'm already living paycheck to paycheck. I have insurance for
myself and my two sons. Just bought a house that we can barely
afford and it's barely meeting our needs.
Utah
Brittanie
We will not be able to eat consistently; this will cut out more
than 60% of our food budget for the month
Illinois
Larissa
I am 61 and am [my husband’s] sole caregiver and need to be at
home. We have been living paycheck to paycheck trying to
make ends meet and cut wherever we can. Finances are
constantly on my mind! I was able to have my insurance through
Vermont Health Connect and received tax credits that enabled
me to have health insurance. Being told those tax credits are
ending in December of this year has me panicking because I will
not be able to afford the health insurance premium and am afraid
I will no longer have health insurance. I don’t know what to do.
Vermont
Michele
Ours would more than double in New Mexico. Our premiums
would increase $600 to $3800 for same policy we have for a
family of 3 if the enhanced subsidy goes away. We would not be
able to afford health insurance. We would be at risk of medical
bankruptcy if anything serious happened. I wouldn’t get the care
I need living with autoimmune disease. I would have rethink [to]
whether or not I let my kid play soccer fearing a risk of some
New Mexico
Jenn
11 Lo, et al. “ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced
Premium Tax Credits Expire.” KFF (2025). https://www.kff.org/affordable-care-act/aca-marketplace-premium-
payments-would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/
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injury. At these rates, I don’t think catastrophic policies are even
affordable.
I am a single mom with a mortgage. I make only $60,000 a year.
That means I will have to choose between paying my mortgage
or paying for healthcare. I think that will be a no-brainer because
I need a roof over my head that also means my child and I will
be left without any healthcare and more than likely unable to
survive.
California
Aisha
This will make basic healthcare unaffordable. We just moved
into our first home and now I'm concerned that we won't be able
to afford basic services like food, electricity and heating.
Massachusetts
Jason
I was laid off from my job of 30 years May of this year. Had
excellent benefits, vision, and dental. Right now through the
ACA I am paying as much as I did through my employer, but
dental and vision is not offered through the ACA. I have not
found a job yet, I’m sure it is because of my age. If my premium
goes up, double or triple I do not know how I will be able to
afford all my basic needs. Will be very much a hardship, I live
alone, so do not have any other income.
Texas
Tamara
We will simply not be able to afford it. We are normal people
making a normal wage, but we have NO EXTRA.
Minnesota
Johanna
I had been hoping to move out of my parents' place and get a
condo, start building some equity as I get older, but now?
Unlikely.
Florida
Ashley
I have an elderly grandmother on Medicaid and I'm a
physician...I can't stand seeing my community or family or
neighbors getting squeezed on something that's so essential. It is
not American to only think of yourself and turn away when
others so close are suffering or about to suffer needlessly.
Maryland
Jessica
I’m self-employed and have consistently earned about $40,000
for each of the last 20 years. I updated my health insurance plan
a few weeks ago and was shocked by the warning about the loss
of the advanced federal subsidy. Rather than a premium of
$100/month, I could be paying more than $1200/month or 35%
of my income, and that’s before deductibles and copays.
Vermont
Cara
If my insurance premiums go up that is going to be a real
struggle for me and my family. We are already struggling to pay
for groceries and insurance and bills. And we make a pretty
decent wage in my family. Why make changes to affordable
care? Healthcare is a necessity and this will be devastating to so
many people.
Wisconsin
Nycole
So I either accept the increased price of ACA AmBetter, or I go
uninsured…or I move outside the U.S., where healthcare is
comparatively cheaper. On Facebook, there is a group named
“Senior Nomads,” who all left the U.S. in part to not be
vulnerable to financial ruin due to such healthcare costs.
Florida
Sarah
Rising healthcare costs for my family and others will have a
negative impact on our quality of life and will determine how
much or how little we can spend in retirement.
Illinois
Marc
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Small business owners and workers will suffer
Nearly half of adults who buy their own health insurance operate or work at a small business.12
This is because smaller businesses are less likely to offer employer-sponsored health coverage as
a benefit than larger businesses. In 2024, only about half of companies with 49 or fewer workers
offered health benefits, compared to over 92% of firms with over 50 workers.13
As a result, premium tax credits are critical for Americans who choose to start their own business
or work at a small business. Nearly three quarters of small business owners support extending the
enhanced premium tax credits and oppose cuts to Medicaid.14
Table 3: Small business owners and workers will suffer
Response
State
Name
I am a small business owner and if my health care costs continue
to rise, I will be forced to close my business and look for a job if
I can find one
Pennsylvania
Joe
I make approximately 30k net from my part time business, I am
the caregiver of my husband [who] is disabled that is on SSA. I
am afraid of losing of losing my insurance because even though
I am in good health, I am 53 years old. I cannot get another job
because we are 1.45 hours to the nearest metro area and I cannot
leave my husband alone 12 hours a day. I am glad my husband
will still have insurance, but scared for myself.
Maine
Lynette
As a small business owner in Vermont, I am very concerned
about the rising cost of health insurance. I don't think I'm going
to be able to keep my business open without the federal
subsidies. Vermont Health Connect has been instrumental in
providing me with care these past few years. I would hate to
have to shutter my doors of a successful business just because I
can no longer afford health insurance.
Vermont
Mindy
I'm getting older. 34, working a job at a small business as their
marketer. They don't have benefits, and given the city I live in, I
don't make enough to afford rent and food and health insurance.
Only 2 of those things do I need to survive. These cuts make it
even more impossible to turn things around and get a handle on
health issues.
Colorado
Sebastian
We are a homeschooling, small business family with a
landscaping company. My husband often works weeks without a
single day off. We are FINALLY getting ready to hire our first
employee and will now be hit with insurance premiums we
aren't sure how we are going to pay on top of increasing payroll,
increasing food prices, increasing equipment and vehicle costs
Florida
Katherine
12 McGough, et al. “About Half of Adults with ACA Marketplace Coverage are Small Business Owners, Employees,
or Self-Employed.” KFF (2025). https://www.kff.org/affordable-care-act/about-half-of-adults-with-aca-marketplace-
coverage-are-small-business-owners-employees-or-self-employed/
13 “2024 Employer Health Benefits Survey.” KFF (2024). https://www.kff.org/health-costs/2024-employer-health-
benefits-survey/
14 “The expiration of the ACA’s enhanced premium tax credits will devastate the small business community.” Small
Business Majority (2025). https://smallbusinessmajority.org/sites/default/files/policy-docs/Impact-of-EPTCs-on-
Small-Business%20Owners%202025.pdf
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our business faces. We have to have healthy employees to have
a healthy company. We have to have an affordable life to have
the capital to grow a business to that level. It feels a bit like
climbing a mountain with all the rocks that we can grab onto
slipping as we climb higher to a top we can't see.
I'm a self employed person. Today, I make enough from my self
employment that I no longer qualify for any of that, and I'm
proud of that! Medicaid made it possible for me and my family
to survive and for me to work to get us out of poverty. The ACA
is basically a miracle to me. If I were to lose the ACA, I would
have to leave my GOOD PAYING TAX PAYING JOB. I would
have to quit my dream job as an author to INTENTIONALLY
lower my income so we could qualify for Medicaid. The loss of
the ACA would be devastating and would mean I actually have
to intentionally work less. I'd have to tell my husband "Stop
looking for work. We can't afford to lose our insurance." It
actually becomes a wise financial decision for us to leave the
work force. The ACA and those subsidies are there for people
like [me]. They are one of the key pieces we NEED to make the
American dream possible for low income Americans like me.
New Mexico
Elizabeth
Rural Americans will struggle
The Affordable Care Act and Medicaid are critical to rural America. In fact, in the ten largest farm
states between one-fifth and one-third of the states’ populations rely on either Medicaid or the
Affordable Care Act for their health insurance.15 In 2023, over one-in-four farmers and ranchers
relied on individual market coverage. 16 Most farmers are self-employed so obtaining health
insurance can be harder than for individuals who work at businesses that offer health coverage.
Table 4: People living in rural areas are afraid of losing access to care
Response
State
Name
Our rural communities are now more than ever being raked over
the coals for not only the increased costs for premiums. We have
no other emergency care in our areas that are not "hospital"
owned. We have to drive an hour in any direction to visit a non-
emergency room facility. The emergency room costs are insane
and insurance deductibles and premiums don't even begin to
cover something as simple as [a] cut on an arm.
Virginia
Matthew
I am a nurse in East Tennessee and I work in a small hospital.
My hospital itself does rather well however the surrounding
rural communities have even smaller hospitals that will likely
close or be underfunded. As a result of this, it will cause the
residents of these communities to travel further for care into the
small hospitals that remain open will be inundated with more
and more patients with not nearly enough beds, nurses, and other
Tennessee
Heather
15 Katherine Hempstead. “Marketplace Pulse: Health Insurance Coverage in Farm Country.” Robert Wood Johnson
Foundation (2024). https://www.rwjf.org/en/insights/our-research/2024/05/marketplace-pulse-health-insurance-
coverage-in-farm-country.html
16 Cynthia Cox and Gary Claxton. “Occupations with Large Shares of Workers Who Rely on Individual Market
Coverage.” KFF (2025). https://www.kff.org/affordable-care-act/occupations-with-large-shares-of-workers-who-
rely-on-individual-market-coverage/
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healthcare providers. We are already stretched so thin,
overworked, and underpaid. This burden results in an extensive
systemic crisis that causes more than just a lack of health care
availability.
My mom who is 87 counts on the rural hospital in her town of
Pilot Knob, Mo. My niece and nephew need Medicaid. Please
hold the line!
Missouri
Elizabeth
My biggest concern is that our federally funded rural health
clinics and our hospitals in our remote rural county (California's
northern Redwood Coast) will close. Humboldt County
California is sometimes referred to as Western Appalachia
because of poverty and addiction rates. Many medical providers
have retired or moved to bigger cities. If our local clinics and
hospitals close, as they are likely to with federal funding
disappearing along with health insurance becoming
unaffordable, people will die.
California
Patricia
I have friends that are retired and live in rural communities that
they will either lose the closest hospital to them causing an
increase of as much as an hour to get to a hospital...they will
likely die if they can't get their care locally. I have family that
uses the ACA, our niece is close to 40 and she will lose care,
because she won't be able to afford it, and she has a pre-existing
condition that if it doesn't kill her, it will be a miracle.
Oregon
Catherine
My community health center (which is the only doctor in my
rural area) offers a sliding scale so I may be able to afford care
for emergencies, but if they close I don't know if I could afford
to see a doctor again unless I got insurance. It is not offered
through my job, so that may impact me trying to find a different
job which would have a direct impact on my community as I am
a childcare worker, and we are already short staffed. It would be
devastating to lose insurance or to have higher premiums and
need to make the hard choice between groceries, rent, student
loans, and health insurance. Unfortunately health insurance is
what I would have to cut.
New York
Sheila
IV. Americans are Already Starting to Hear About Soaring Premiums
The 24 million Americans who buy their own health insurance will all be able to see how much
their premium will increase on November 1—or 25 days from now. But some states have started
sending notices and opening up their websites. Georgia, Idaho, Maryland, New York and Virginia
have all opened up “window shopping” to allow people to compare health plans for 2026.
HELP Minority staff reviewed state marketplace websites to understand the changes in premiums
working Americans will soon face. The results are outrageous. Americans are about to pay
substantially more for the exact same coverage.
13
For example, a couple in their sixties living in Rappahannock County, Virginia earning
$85,000 per year will pay over $1,500 more per month for a plan that already has an $8,600
deductible. The couple would go from paying $649 to $2,195 per month.
Figure 4: Virginia Premium Increase for Exact Same Plan
14
Outside Rome, NY, a family of four with a household income of $135,000 will pay nearly
$900 per month more, from $2,575 to $3,446 per month, for a plan with a narrow provider
network.
Figure 5: New York Premium Increase for Exact Same Plan
15
A 60-year-old couple in Salisbury, MD that makes $90,000 per year will pay more than
double their current monthly premium—over $1,100 more per month. A plan that used to
cost $641 will now cost $1,762 per month.
Figure 6: Maryland Premium Increase for Exact Same Plan
16
A 32-year-old in Coeur d'Alene, ID making $42,000 will pay an additional $125 per month
for the same coverage, $1,500 over the course of a year. Their plan will go from $283 to
$407 per month.
Figure 7: Idaho Premium Increase for Exact Same Plan
17
A couple in Savannah, GA with two adult children living at home with them and making
$129,000 per year, will pay an additional $3,150 per month for health insurance, from $941
to $4,089 per month.
Figure 8: Georgia Premium Increase for Exact Same Plan
18
V. Cost Increases and Coverage Losses Will Hit All 50 States
This is just the beginning. Over the next month, families in more and more states will get notices
of huge premium increases or be faced with massive sticker shock when they go to sign up for
coverage.
States that operate their own health insurance marketplace websites are already warning people
that their premiums will go up (Table 5). Other states rely on the Federal health insurance
marketplace known as HealthCare.gov, which is not expected to share details on possible rate
increases until immediately before the beginning of open enrollment (November 1, 2025).
Table 5: People are Beginning to See the Effects of Premium Increases17
State Window Shopping Begins Personalized Notices Sent to People
CA
10/15
10/15-11/6
CO
N/A
N/A
CT Late October
10/19-10/24
DC Mid-October
Mid-October-November
ID 10/1
N/A
IL
10/27
10/27
KY
10/15
Mid-October
MA Mid-October
Mid-October
MD Early October
Early October
ME 10/15
10/20
MN
Mid-October
Mid-October
NJ
October
Late October-Early November
NM 10/15
10/27
NY 10/1
Mid-October
OR 10/15
N/A
PA
N/A
Late October
VA
10/1
10/25
VT 10/15
Late October
WA 10/21-10/30
Mid-to-Late October
These premium increases will be a disaster for millions of Americans, on top of the other historic
cuts to Medicaid and the Affordable Care Act. Taken together, the Republican health care cuts will
substantially increase, and in some cases double, the uninsured rate in states across our nation.
17 Adapted from data compiled by the State Marketplace Network.
19
Table 6: Republican Policies Will Lead to a Massive Increase in Americans Losing Health Insurance18
State
2023 Uninsured Rate
2034 Uninsured Rate
Percent Increase
Alabama
8.2%
10.8%
36.0%
Alaska
10.0%
13.7%
39.6%
Arizona
9.6%
14.2%
58.8%
Arkansas
8.9%
13.4%
51.3%
California
6.2%
9.9%
69.8%
Colorado
6.5%
8.6%
49.7%
Connecticut
5.4%
9.6%
76.7%
Delaware
6.6%
10.5%
67.3%
District of Columbia
2.6%
6.3%
182.9%
Florida
10.4%
15.6%
63.6%
Georgia
11.1%
14.5%
41.0%
Hawaii
2.7%
5.2%
109.4%
Idaho
8.8%
10.3%
28.9%
Illinois
6.0%
10.1%
69.1%
Indiana
6.6%
10.5%
64.3%
Iowa
4.9%
8.1%
70.2%
Kansas
8.1%
10.1%
26.5%
Kentucky
5.5%
10.1%
88.9%
Louisiana
6.7%
13.5%
107.0%
Maine
5.9%
8.3%
40.2%
Maryland
6.2%
9.0%
55.1%
Massachusetts
2.5%
5.2%
118.3%
Michigan
4.3%
8.1%
90.0%
Minnesota
3.9%
6.6%
80.0%
Mississippi
10.1%
14.0%
37.1%
Missouri
7.3%
10.9%
51.1%
Montana
8.3%
12.1%
53.4%
Nebraska
6.2%
8.4%
44.3%
Nevada
10.5%
12.4%
32.8%
New Hampshire
4.4%
6.6%
51.4%
New Jersey
7.0%
10.7%
59.8%
18 To compute the 2023 uninsured rate, HELP Minority Staff divided the KFF estimate of the number of uninsured
people in each state by the U.S. Census’s estimate of state’s population. To compute the 2034 uninsured rate, staff
added the KFF estimate of the increase in uninsured population per state, which used CBO estimates, to the 2023
uninsured population and divided by the KFF’s projected 2034 population, which uses data from the Weldon Cooper
Center for Public Service. To compute the percent increase in uninsured population, staff divided the projected
increases in uninsured population by the 2023 uninsured population. “How Will the 2025 Reconciliation Bill Affect
the Uninsured Rate in Each State?” KFF (2025). https://www.kff.org/medicaid/how-will-the-2025-reconciliation-
law-affect-the-uninsured-rate-in-each-state/. This likely represents an undercount of the true increases in uninsured
for each state.
20
New Mexico
8.7%
13.1%
53.0%
New York
4.7%
8.5%
93.4%
North Carolina
8.9%
12.4%
46.6%
North Dakota
4.0%
6.3%
83.1%
Ohio
5.9%
9.7%
65.9%
Oklahoma
11.0%
15.1%
40.4%
Oregon
5.3%
9.3%
92.9%
Pennsylvania
5.2%
8.6%
66.4%
Rhode Island
4.3%
7.9%
89.4%
South Carolina
8.7%
11.7%
40.5%
South Dakota
8.3%
10.0%
26.2%
Tennessee
9.0%
11.4%
32.6%
Texas
16.0%
18.5%
28.8%
Utah
7.6%
10.5%
57.9%
Vermont
3.3%
6.0%
84.9%
Virginia
6.2%
9.6%
65.2%
Washington
6.2%
10.3%
89.3%
West Virginia
5.8%
10.4%
73.7%
Wisconsin
4.8%
6.5%
38.9%
Wyoming
10.2%
11.8%
16.3%
Bottom line: Republican health care cuts will mean people will get sicker. Some will die. In the
richest country in the history of the world, we cannot allow that to happen. These cuts must be
reversed. We must also work to end the international embarrassment of the United States being
the only major country on earth that does not guarantee health care for all.
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