WV will be among states hardest hit if health insurance tax credits expire, analyst says

by Lori Kersey, West Virginia Watch
August 15, 2025

Tax credits that have made health insurance affordable for millions of Americans are set to expire at the end of the year, and West Virginia will feel the effects more than most states, a health policy expert said.  

The “One Big Beautiful Bill Act” that President Donald Trump signed into law last month did not extend the Biden-era enhanced premium tax credits for people who buy their health coverage on the Health Insurance Marketplace though the Affordable Care Act. Unless Congress acts to change that, the 67,000 West Virginians who buy health care on the marketplace will pay more beginning in 2026. 

“We anticipate that everyone on the marketplace will see a spike in the price of their coverage,” said Rhonda Rogombe, health and safety net policy analyst for the West Virginia Center on Budget and Policy. 

The Center on Budget and Policy said that West Virginians who buy insurance through the marketplace will see their premiums increase by an average of 133% or $1,400 annually. About 15,000 West Virginians will lose health care altogether because they cannot afford it any more, according to the CBP. 

The expanded tax credits, which are income based, were part of the American Rescue Act of 2021 and extended through 2025 in the 2022 Inflation Reduction Act. 

The average full monthly premium for coverage on the marketplace is $1,170 per person in West Virginia, nearly double the national average of $619 monthly per person, said Louise Norris, a health policy analyst for healthinsurance.org. 

“West Virginia is likely to be the hardest hit in the whole country, just because premiums are higher in West Virginia,” Norris said. “…Before you apply any subsidies, West Virginia has the highest in the country.”

Households that earn more than 400% of the federal poverty level — $128,600 per year for a family of four — will lose their health care subsidies altogether. In West Virginia, nearly 10% of families who buy their health care on the marketplace fall into that category, Norris said. 

“They could be facing very unaffordable, full-price premiums next year, which is particularly challenging in a state like West Virginia, where the premiums are so high,” she said. 

Those who make less than $128,600 for a family of four will still get a subsidy, but it won’t be as big, Norris said. 

According to estimates by the nonpartisan Congressional Budget Office, the tax credits expiring will lead to 4.2 million people losing their health insurance coverage by 2034. 

Norris and Rogombe noted that Congress could still act to extend the subsidies before the end of the year. 

Congress is expected to return to session in September after a break this month. Open enrollment for the Health Insurance Marketplace plans starts Nov. 1. 

Some Republican Congress members, including Sen. Tommy Tuberville of Alabama, Sens. Lisa Murkowski of Alaska and Thom Tillis of North Carolina, have said they’d support extending the tax credits. 

All of West Virginia’s four-member Republican congressional delegation voted in support of the One Big Beautiful Bill Act. None of them responded to West Virginia Watch’s question about whether they would support extending the tax credits. 

Sen. Shelley Moore Capito, R-W.Va., told Politico last month that “[addressing the tax credits] is “coming, but in senatorial times, we have time to deal with this.” 

Kanawha County resident Ellen Allen is the director of West Virginians for Affordable Health Care. As a customer of the Health Insurance Marketplace, Allen would personally feel the effects of the tax credits expiring.

This year, Allen pays about $500 per month for her coverage and a federal government subsidy pays for the rest of the premium — about $1,400, she said. 

Allen expects her subsidy to be completely eliminated beginning next year. While the exact premiums for next year haven’t been announced, she expects to pay $2,700 per month for health coverage. 

At 64, Allen has one more year until she’ll be eligible for a health insurance plan through Medicare. Allen said she’ll put money away to pay for coverage before she’s eligible for Medicare, but she’s aware that others may not be able to. 

“Mine is as high because, one, I’m so old and the household income is a lot higher than the median,” Allen said. “But even on the median, what you’re going to see go up is their out of pocket, which makes insurance hard for people to use. There’s a lot of studies out there that show when costs go up, utilization of insurance goes down.”

Mariah Plante, community engagement, outreach and story collection coordinator for West Virginians for Affordable Health Care, expects her subsidy to decrease from $611 per month to $474, leaving her with around $150 to $200 per month to pay. Added to her health care expenses is a $150 per month medication that insurance will not cover. 

“So at the end of the day, all told, just for the privilege of having insurance and taking one medication every month, I’m going to be paying $350 that’s before I pay a copay for a doctor’s appointment or see a dentist or get my month, my yearly pap smear, or anything like that,” she said. That’s just to exist and be insured.”

Plante said the cuts to Medicaid and to the Affordable Care Act in the big beautiful bill are confusing. It’s difficult for people to understand how they’ll affect everyone, she said. 

“Even people who are getting the enhanced premium tax credit may not know that they’re getting it, or may not understand just how much it is contributing to their health care,” Plante said. “And they’re not going to understand it until they see those costs go up in real time. I think that it’s likely a purposeful thing.

“It’s so complicated to understand and explain, because that makes it harder to educate folks and combat against,” she said. 

Besides the changes that may come to provisions of the Affordable Care Act, the “One Big Beautiful Bill Act” cut the Supplemental Nutrition Assistance Program by $186 billion and cut Medicaid spending by $326 billion over 10 years.

Altogether, the changes in the bill will mean West Virginia will lose about $1 billion in federal funding every year, and work reporting requirements for Medicaid are likely to cause between 50,000 and 110,000 West Virginians to lose their health care, Rogombe said. 

“These provisions won’t go into effect for at least a year, and so we won’t see the impacts of this until, really, by 2027 is when we’ll start to see the impact,” she said.

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West Virginia Watch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. West Virginia Watch maintains editorial independence. Contact Editor Leann Ray for questions: info@westvirginiawatch.com.