More than 25,000 Alaskans who buy health insurance through the federal marketplace will face massive and possibly unaffordable cost increases if federal subsidies expire at the end of the year.
“I do think it’s important to recognize that we should be seeing thousands of people likely lose coverage from this,” said Jared Kosin, president and CEO of the Alaska Hospital and Healthcare Association.
In a panel discussion last month, local experts in Juneau laid out the stark reality for Alaska, which has the highest health care costs in the nation.
Speaking to a room at Juneau’s convention center, they said if federal subsidies end, the cost of health insurance would rise so much that many Alaskans will go uninsured, discouraging them from getting checkups that could prevent serious illnesses. Hospitals would see a larger number of emergencies from uninsured people, straining them.
It might even lead to an exodus from the state, as people seek alternative options and cheaper places to live.
“I worry about that,” said Kim Champney, executive director of the Alaska Association on Developmental Disabilities. “Because I think people will decide to leave Alaska because we have the most expensive health care in the country.”
Anton Rieselbach, with the Juneau Economic Development Council provided an analysis of cost estimates for Juneau. In Alaska’s capital city alone, 1,389 people receive health care via insurance plans bought through the federal marketplace. Right now, those people pay an average of $124 per month. If those subsidies expire, that will rise to $1,008 per month, an increase of more than 700%.
More than 100 people in Wrangell buy their coverage through the marketplace, according to federal statistics.
The potential cost increase stems from federal subsidies enacted by Congress in 2021 and extended through the end of 2025. Those subsidies, known as “enhanced premium tax credits,” were applied on top of subsidies included in the original Affordable Care Act, which established the federal insurance marketplace.
Now, almost anyone who buys an individual health care plan through the marketplace gets some kind of subsidy.
Generally, that includes people whose employers don’t provide health insurance, self-employed people, and people who retired early and aren’t yet eligible for Medicare, which insures people with disabilities and people 65 or older.
Subsidies helped expand the number of people on federal marketplace plans from 11.4 million in 2020 to 24.3 million this year, allowing millions of Americans to get regular health care.
They also came at a high cost to the federal treasury: Extending them for another 10 years would cost $335 billion.
But if subsidies end, Alaska would be exceptionally hard-hit. The state has the highest health-care costs in the nation, which means unsubsidized insurance rates are high.
In 2023, 2024 and 2025, the average cost of a health insurance marketplace plan in Alaska rose by more than 16% each year. In 2023 alone, the cost went up by an average of 18.4%.
Of the 28,736 Alaskans who have health insurance policies through the federal marketplace, 25,170 receive the enhanced subsidies, according to figures published by the Centers for Medicare and Medicaid Services.
According to estimates published in March by the Alaska Division of Insurance, a single 50-year-old who earns $58,650 per year would see their monthly health insurance cost rise from $282 per month to $407 per month for a “silver” plan. If they have a “bronze” plan, with fewer benefits, their costs wouldn’t change.
But Alaskans who earn more than 400% of the federal poverty line — $78,000 per year for an individual — would see their costs skyrocket.
That same 50-year-old would go from paying $534 per month for a silver plan to $1,415 per month. Under a bronze plan, their cost would go from $9 per month to $890 per month.
“It’s an insane amount,” said Anchorage Rep. Genevieve Mina. This spring, Mina sponsored and the Alaska Legislature passed a resolution, a bipartisan letter asking Congress to extend the subsidies.
Kosin, of the hospital and healthcare association, said his group thinks it’s “really important” to extend the enhanced subsidies.
Insurance is based on the concept of sharing risks and costs. The more people in an insurance pool, the better it works. Subsidies encourage healthy people to be a part of the health insurance pool, he said. If people drop off, the cost of caring for any individual person is spread among fewer members, and rates go up.
Open enrollment on the federal insurance marketplace starts Nov. 1. There’s a “window shopping” period at the end of October that will give a sneak preview.
People must sign up by Dec. 15 to get insurance coverage that starts with the new year.
U.S. Sen. Lisa Murkowski is among the members of the U.S. Senate who have been trying for months, without success so far, to find enough votes to extend the subsidies.
The issue has now gotten entangled with the impending government shutdown that will start Oct. 1 unless Congress can pass a spending bill. Senate Democrats have demanded — among other things — a permanent extension of the health care subsidies, without changes, in exchange for their votes on keeping the federal government open.
Murkowski is interested in a straight extension without changes. She introduced a standalone two-year measure and voted against Republican and Democratic proposals to keep the government open, saying one of her conditions was an extension of the subsidy.

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