Rev. Dr. Marion Talley, an Affordable Care Act navigator in Jackson, said the change is already showing up in the people she’s helping enroll.
“I just finished with a person who was paid five dollars and her cheapest policy was two hundred and fifty dollars … So, obviously, they cannot handle that.”
Talley works with Get Covered Mississippi through Oak Hill Regional CDC and said she’s spent years helping people sign up. She described this open-enrollment season as “very, very difficult,” with some clients who had been paying token premiums now seeing triple-digit monthly costs, even before accounting for high deductibles.
Centers for Medicare & Medicaid Services reported 338,159 Mississippians selected ACA marketplace plans during the 2025 open enrollment period. Only around 67,000 have renewed their coverage for 2026, according to Mississippi Insurance Commissioner Mike Chaney.
If large numbers of people end up uninsured, Chaney warned the disruptions could ripple through the broader health care system.
“These people end up without insurance and they have to go to the doctor. They'll end up going to the emergency rooms for uncompensated care,” Chany said. … “It's a death spiral for the healthcare industry at the rate we're going.”
The “enhanced” premium tax credits were expanded during the pandemic and are set to expire at the end of 2025 without congressional action, a shift that policy analysts say would raise what many consumers pay each month, especially for middle-income families without access to employer-sponsored health insurance.
KFF, a nonprofit health-policy organization, estimates that ending the enhanced credits would increase premium payments by 114% on average, about $1,016 more per year, though the impact varies widely by income, age and location.
Talley said that uncertainty is fueling confusion, delay and, in some cases, people walking away from the marketplace.
“Even if the person could pay the premium, the deductible would get them,” Talley said. “I don’t know what people are supposed to do.”
When people can’t afford marketplace plans, Talley said she often directs them to community health centers in Jackson, but those clinics can have long waits and may not offer the specialists people need.
Talley tied the pressure back to Mississippi’s decision not to expand Medicaid, arguing that community health centers were already “full” before the new wave of higher premiums and deductibles.
“Mississippi is the highest in terms of those people who are going to be hurt by this,” Talley said.
KFF estimates that if Mississippi expanded Medicaid, about 123,000 uninsured adults could become eligible, including tens of thousands in the “coverage gap” who earn too much for traditional Medicaid but not enough to qualify for subsidized marketplace coverage under standard ACA rules.
Open enrollment on HealthCare.gov continues through Jan. 15, and federal enrollment materials say people who enroll by then can have coverage begin Feb. 1.
Chaney urged consumers not to wait, saying coverage is still available and people should focus on whether their doctors are in-network.
“Even if it’s the cheapest plan you can get, a bronze plan, get insured,” Chaney said. “Just because it’s not free is not a reason not to have it.”
Nationally, the looming deadline has become a major point of contention in Washington. House Republicans introduced a health plan in mid-December that does not extend the enhanced ACA subsidies, even as the current credits are set to expire at year’s end.
The Wall Street Journal likewise has reported that GOP leaders see no chance of a deal before the deadline, making any potential fix more likely to spill into January.
Talley said she has tried contacting members of Mississippi’s congressional delegation to describe what clients are facing, but says she has not heard back.
“If I could tell them anything, think about the people and actually represent Mississippi.”
