Health insurance premiums could double for 632K in SC with subsidy cuts

When open enrollment begins for almost 632,000 South Carolinians on Saturday, they may see their health insurance premiums more than double, according to reports from nonprofit health research organization KFF.

At the end of the year, enhanced Affordable Care Act subsidies expire, potentially leaving well over half a million people participating in the marketplace in South Carolina with higher costs. Some people will not be able to pay the new price, leaving them without health insurance, said Nathan Boucher, a public policy and nursing associate research professor at Duke University.

“Everybody’s going to see a rise in cost,” Boucher said. “And those who are on the lower income spectrum, they could just not have insurance whatsoever. But even people on the upper echelon are going to feel the pinch.”

On top of expiring subsidies, marketplace premiums are also going up. In states using the federal marketplace, including South Carolina, premiums have risen 30% on average, according to KFF analysis. South Carolinians can now view available plans and prices for 2026.

Of the South Carolina residents that are enrolled in a marketplace plan, over 95% use premium subsidies, some of which will expire, according to a May report from the South Carolina Institute of Medicine and Public Health. The subsidies allow people to purchase private health insurance at a discounted rate.

The tax breaks for people participating in the marketplace are the center of government shutdown debates. While some Republicans have said they would be open to negotiating subsidies after reopening the government, Democratic lawmakers want a permanent extension in the budget compromise.

Without any extension, the tax breaks expire at the end of the year, and open enrollment begins Nov. 1.

The enhanced subsidies doubled enrollment in the Affordable Care Act marketplace nationwide, according to KFF.

If fewer people in South Carolina are insured due to rising costs, the cost of uncompensated care could also go up, Boucher said. That could impact rural hospitals and health care providers ability to stay open, he said.

People in rural areas could be the most impacted by the change, said Maya Pack, the executive director of the South Carolina Institute of Medicine and Public Health. Rural Upstate counties see the most savings from premium subsidies, according to her organization’s report.

“The areas of our state that the subsidies helped the most were our rural areas that are traditionally under resourced and had high rates of people lacking insurance,” Pack said. “Unfortunately, if these subsidies expire, it’s going to hurt people across the state but particularly people in rural South Carolina.

What subsidies are expiring?

People who don’t have health insurance through their employer or the government can get their insurance through the Affordable Healthcare Act marketplace. South Carolina could see a greater impact than other states because it doesn’t have an expanded Medicaid program, Pack said. People that don’t qualify for Medicaid but cannot afford the price of the new premium could go uninsured.

“If that [subsidies] goes away, there are not a lot of options for people,” Pack said.

The enhanced subsidies went into effect in 2021 in the American Rescue Plan Act as a response to the COVID-19 pandemic. They were then renewed in the Inflation Reduction Act. However, Congress did not renew the credits in the budget reconciliation bill passed over the summer.

Changes to premiums will depend on where people fall on the federal poverty level. The level is determined by income and household size.

If the enhanced subsidies expire, households earning 400% more than the federal poverty level will no longer receive credits. South Carolinians earning between 100% and 400% more than the federal poverty level will receive smaller subsidies and have to pay a higher percentage of their income towards health insurance.

For example, a person making more than $62,600 a year will no longer be eligible for the subsidies, according to federal poverty level guidelines. Individuals making between $15,560 and $62,600 will see smaller subsidies. For a family of four, a household making over $128,600 would no longer be eligible for the subsidies. Households making between $32,150 and $128,600 would see smaller subsidies.

That means everyone using the subsidies could see a spike in their premium. KFF projects that a South Carolina 40-year-old making $32,000 a year could pay $180 a month, up from $58. A 60-year-old couple making $85,000 in South Carolina’s 2nd Congressional District, which stretches from Aiken to Columbia, could pay $2,422 a month, up from $602, according to KFF. Those calculations are based on the benchmark Silver Plan.

With costs rising, more South Carolinians’ could become uninsured, Pack and Boucher warned. It could lead to worse outcomes for many residents in the long term, Pack said.

“Our state already has some seriously poor health outcomes, particularly in our rural areas, that are going to be hardest hit by this change,” Pack said. “So those health outcomes will play out over many years and decades. It’s not an immediate impact, but it is something that’s of concern.”

This story was originally published October 30, 2025 at 5:00 AM.