Overview

A critical moment is approaching for millions of Americans who rely on Affordable Care Act (ACA) health insurance-and most don't even know what's coming. Across the country, insurers are filing sharp premium increases for 2026, with some states projecting jumps of 20-35% or more. For many households, especially those who rely on enhanced premium tax credits, the loss of temporary subsidies could mean their monthly payments doubling overnight. Sticker Shock dives deep into the forces behind this surge and explains what it means for consumers, policymakers, and the insurance market as a whole. Combining data-driven analysis with clear, accessible explanations, this book breaks down the complex drivers of premium hikes-from medical cost inflation and hospital pricing to risk-pool pressures, insurer strategy, and federal policy uncertainty. You'll discover: Why premiums are rising so sharply-and why 2026 may be the breaking point Learn the economic, political, and actuarial forces pushing costs upward, including the looming expiration of enhanced subsidies. How the loss of enhanced premium tax credits could reshape the entire marketplace Understand how millions of families could see their net monthly premiums more than double, and why insurers are preparing for major risk-pool changes. State-by-state variations and real examples from high-impact markets Explore case studies from states like Texas-where average premiums are projected to rise over 30%-and the differences between federal marketplace states and state-run exchanges. What consumers can do NOW Practical guidance on comparing plans, estimating subsidies, navigating metal tiers, and finding lower-cost alternatives or state assistance programs. What insurers, regulators, and lawmakers must consider Insight into policy options, reinsurance strategies, risk-adjustment reforms, and the legislative decisions that will determine whether the ACA remains stable or enters a period of volatility. Scenarios for the future Will Congress extend subsidies? What happens if they expire? How will premiums evolve over the next 5-10 years? This book presents clear, evidence-based projections. Informative, timely, and highly relevant, ""Sticker Shock"" is essential reading for anyone who wants to understand the coming premium surge-before it hits. Whether you're a consumer, policymaker, educator, advisor, or health-policy observer, this book offers the clarity and insight needed to navigate one of the most consequential moments in the ACA marketplace's history. Prepare for what's coming. Knowledge is the best protection against Sticker Shock.

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