Nevadans purchasing health insurance on the individual marketplace this year could have to pay an additional $147 each month, and that’s not counting the looming expiration of Affordable Care Act subsidies that are likely to drive insurance bills even higher.

Democrats have made preserving the subsidies the centerpiece of their negotiations to fund the federal government and appear prepared for a shutdown unless congressional Republicans agree to extend them. Congress boosted existing Affordable Care Act (ACA) subsidies in the form of tax credits under the Biden administration, but they are set to expire this year.

Jared Ortaliza, a policy analyst at the health policy and research organization KFF, said as health insurance costs rise, more people become uninsured and further strain the health care system, driving costs up even further.

“The enhancement and tax credits have made financial assistance for marketplace coverage more generous, allowing enrollees to pay as low as $0 a month,” Ortaliza told The Nevada Independent. “In some cases, if the enhanced payment tax credits expire, premium payments for enrollees could go up significantly starting next year.”’

In Nevada, 2025 records show that more than 110,000 Nevadans enrolled in health coverage through the marketplace — an 11.5 percent increase from 2024 — and 95,000 Nevadans receive enhanced subsidies. KFF estimates the loss of the enhanced subsidies could lead to more than 24,000 Nevadans not having insurance in 2034. 

Ortaliza said that among insurers KFF evaluated, the expiration of the tax credits would lead insurance rates to rise an average of 4 percentage points more than they otherwise would.

Congressional Budget Office estimates indicate that if that happens, nearly 4 million more Americans will become uninsured each year. The office also projects that permanently expanding the enhanced subsidies would increase the number of people with health insurance by 3.8 million and raise the federal deficit by $350 billion by 2035.

In August, Nevada Division of Insurance officials projected health insurance rates would increase 17.5 percent. But the finalized rates submitted by insurers in September will increase premiums for those purchasing insurance on the marketplace by an average of 26 percent, or $147 each month. Officials stressed that premiums are determined by income and subsidy eligibility, so the effect will vary across households.

That 26 percent increase in premiums does not include the effect of the expiring subsidies. If those are not renewed, consumers will see even higher net premiums, or in some cases, may no longer qualify for any subsidies.

Officials with the division said the higher rates follow a national trend and stem from rising medical costs, shifts to Medicaid, higher prescription drug spending, increased use of insurance, a less healthy population and other federal changes.

Acting Commissioner Ned Gaines said in a statement that Nevadans still have choices on the state’s insurance marketplace.

“Most Nevadans qualify for subsidies through Nevada Health Link, which can make coverage far more affordable,” Gains said. “We encourage all consumers to review their options during open enrollment to find a plan that best fits their needs and budget.”

Open enrollment for the upcoming year, which allows Nevadans to compare and select plans through the state’s health insurance marketplace, will run from Nov. 1 through Jan. 15.  

Shutdown showdown

Rising health care costs are especially resonant as political messaging for Democrats. It will be some time before most Nevadans feel the effects of the GOP megabill passed over the summer, but the increased insurance costs will be apparent as soon as Oct. 2, when Nevadans can begin perusing plans on the health insurance exchange.

Democrats are expecting a shutdown when government funding runs out in October, a congressional Democratic staffer, granted anonymity to speak freely, told The Nevada Independent. 

The parties have been stuck in a stalemate since the Senate rejected a House Republican plan that would have kept government funding at the same levels through Nov. 21. Senators also voted down a Democrat-backed plan that would have extended the ACA subsidies permanently and reversed many of President Donald Trump’s spending rollbacks. 

Since then, Nevada Democrats have doubled down. On Thursday, Sen. Jacky Rosen (D-NV) held an event with health care professionals in Carson City about the effects of the expiration of the tax credits. It was, she said, part of a strategy to pressure Republicans.

“They won't come to the table,” Rosen told reporters after the event. “They've been really stubborn. I don't understand it. That's why I wanted everyone to tell their stories. Because, why aren't they listening?”

It’s a message echoed by Nevada’s other congressional Democrats.

“It is on Republicans and President Trump to come to the negotiating table to protect coverage for hardworking Americans and avoid a costly government shutdown,” Arturo Gutierrez, a spokesperson for Sen. Catherine Cortez Masto (D-NV), told The Indy.

Rep. Steven Horsford (D-NV) said Democrats won’t give in on the issue.

“We will refuse to help Republicans dismantle them,” he said, referring to the ACA subsidies, in a statement to The Indy. “They need to fund the government at the end of this month, and Democrats will not vote for any package that fails to extend the tax credits.”

At an event in Las Vegas on Thursday, Rep. Susie Lee (D-NV) called for making the subsidies permanent and pushed back on Trump’s claim that Democrats are demanding too much. 

“We have one thing that we want, and that's to extend these tax credits,” she said. Lee later told reporters, “I have had Republicans in private say to me, we need to reassert our power of the purse. So I'm standing up.”

Nevada’s sole congressional Republican, Rep. Mark Amodei (R-NV), told The Indy he was interested in addressing the rising costs of health insurance — after government funding is settled. 

“That's something I want to talk about,” he said, stressing that he wants to have a conversation about the details of the subsidies. “You're not going to start it under the threat of, ‘Just continue it or we're shutting the government down.’ I'm not going to editorialize, but I think that's bad juju.”

But bipartisan compromise for now appears out of reach. Amodei has instructed his staff to start preparing for a shutdown. 

“Having been through more than a few of these before, it all looks like ‘shut it down’ to me,” he said. 

He thinks a shutdown will be costly to Americans, though not necessarily to his party, given the heat Minority Leader Chuck Schumer (D-NY) took after caving on government funding earlier this year. 

“The Republican leadership, in all quarters, has basically said, ‘We think we like our chances in this,’” Amodei said. “Especially in the Chuck Schumer era, he got blamed for one that happened. And then the one that didn't happen, he got blamed for not making it happen. What flavor of poison would you like?”

Nevadans already feeling the pinch

The financial stain surrounding health care isn’t new.

Abby Madore is an insurance enrollment counselor who helps low-income Nevadans understand their insurance options. She said her clients are already having to choose between paying for food, housing, groceries and health coverage.

“2025 was hard,” she told The Indy. “The prices did go up. … I did see people switching over to lower cost plans, having to lose their providers or specialists just to be able to afford the monthly rate.”

Health care professionals at the clinic Rosen visited Thursday in Carson City said when patients can’t pay, providers will sometimes dig into their own pockets to help cover costs.

Hospitals and health care centers also bear the burden of uncompensated care, and may struggle to keep providers employed if they are not reimbursed. 

Dr. Sangeeta Wagner, the chief integration officer at Nevada Health Centers, said that as patients struggle to pay for insurance, they often choose not to receive preventative care, which then drives up emergency room usage and other health care costs.

“It makes it harder for us providers to do our work. It makes it harder on the patients,” Wagner said. “[With fewer resources,] we try to get more creative, but have, unfortunately, less available to us to take care of our patients, which we took the oath to do.”

Nevada Independent intern Kate Reynolds contributed to this report.