Almost 185,000 lower-income San Joaquin Valley residents – and nearly 2 million statewide – who purchase health insurance through Covered California will see their monthly premiums skyrocket in January after Congress failed to reach agreement on extending “enhanced tax credits” that subsidize a large share of the cost.

The result is that thousands of families likely won’t be able to afford health coverage and will join the ranks of the uninsured, said Jessica Altman, Covered California’s executive director. 

“In a time when costs are rising in so many places and many people are fighting to just meet their daily needs, this is a huge stressor for people and the families that we serve,” Altman told the Central Valley Journalism Collaborative in a recent interview.

Covered California is the state’s insurance marketplace under the federal Affordable Care Act (also known as Obamacare).   

The expiration of the tax credits, if they are not extended by Congress, would increase insurance premiums for subsidized Covered California enrollees by more than double in most of the Valley’s counties, and nearly quadruple in Merced County.

Sept. 30 was an important milestone for Congress to act to extend the tax credits upon which enrollees in Covered California depend to offset a portion of their healthcare costs. Typically, Covered California sends out renewal notices on or about Oct. 1 to notify enrollees of premiums for the coming year, with open enrollment beginning Nov. 1.

But with no action to extend the credit, Altman said, the agency will delay sending the renewal notices until Oct. 15. If by that time Congress has not voted to extend the tax credit, Covered California’s renewal notices will go out reflecting the higher out-of-pocket costs for insurance premiums.

“I have hope, but I don’t have confidence” that Republicans and Democrats will break their deadlock over extending the enhanced tax credit, Altman said. The tax credit was a key partisan sticking point contributing to the Oct. 1 shutdown of the federal government.

Covered California projects that its subsidized enrollees in Valley counties would experience large increases their monthly health insurance premiums if the enhanced tax credits expire:

  • Fresno County: Average increase of 160%.
  • Kern County: Average increase of 160%.
  • Kings County: Average increase of 147%.
  • Madera County: Average increase of 139%.
  • Merced County: Average increase of 388%.
  • San Joaquin County: Average increase of 129%.
  • Stanislaus County: Average increase of 112%.
  • Tulare County: Average increase of 140%.

Premiums for health plans sold by insurance carriers through Covered California were already 

projected to increase by an average of 10.3% – the result of higher costs for health care and prescription drugs, and other industry factors. That increase does not account for the expiration of the enhanced premium tax credit.

In San Joaquin Valley counties, about 202,000 people were enrolled as members of Covered California as of July. Of those, about 91% have their costs at least partially subsidized by tax credits:

  • Fresno County: 48,340 members; 43,590 are subsidized, and their average net monthly premium is $80 per member. There are 4,760 members without subsidies, with an average monthly premium of $540 per member.
  • Kern County: 34,730 members; 31,390 are subsidized, with an average net monthly premium of $86 per member. There are 3,350 unsubsidized members, with an average monthly premium of $558 per member.
  • Kings County: 4,000 members; 3,580 are subsidized with an average net monthly premium of $86 per member. There are 420 unsubsidized members with an average monthly premium of $523 per member.
  • Madera County: 6,960 members; 6,320 are subsidized with an average monthly net premium of $97 per member. There are 660 unsubsidized members with an average monthly premium of $549 per member.
  • Merced County: 18,160 members; 17,050 are subsidized with an average monthly net premium of $24 per member. There are 1,100 unsubsidized members with an average monthly premium of $769 per member.
  • San Joaquin County: 48,320 members; 44,560 are subsidized with an average monthly net premium of $101 per member. There are 3,760 unsubsidized members with an average monthly premium of $608 per member.
  • Stanislaus County: 28,460 members; 26,090 are subsidized with an average monthly net premium of $113 per member. There are 2,370 unsubsidized members with an average monthly premium of $605 per member.
  • Tulare County: 13,170 members; 12,020 are subsidized with an average net monthly premium of $107 per member. There are 1,150 unsubsidized members with an average monthly premium of $695 per member.

Altman said that under the original Affordable Care Act, tax credits or subsidies were available to people whose income put them just over the threshold for Medicaid eligibility – about $22,000 per year for an individual.

“Enhanced” tax credits – a higher level of subsidy – were introduced in 2021 as part of COVID relief legislation. That expanded the eligibility for the tax credits to people and households with incomes above 400% of the federal poverty limit, or about $65,000 for an individual, Altman said. It also capped out-of-pocket costs for premiums at 8.5% of household income.

It’s that expanded range of people for whom the tax credits are set to expire at the end of this year.

“We have a record of just under 2 million enrollees” in Covered California, Altman said. “You have one set of people who are going to see higher costs because they will get less tax credit than they would have otherwise when they go back to the ACA.”

An estimated 400,000 enrollees statewide “are going to lose their tax credits altogether because they’re above that $65,000 level,” Altman added. “Those people are where we’ll see even people having to pay … an average increase of over $500 a month in coverage for that group of people as they lose their tax credits.”

Many of those people could become uninsured, earning too much to qualify for Medi-Cal, the state’s version of the Medicaid insurance program for low-income residents.

KFF, a nonprofit health policy, polling and news organization, reported in September that those residents or households in which income is more than four times the official poverty level won’t qualify for any financial assistance under the Affordable Care Act if the enhanced tax credits expire. 

“These enrollees will not only lose financial assistance but will also be exposed to any increase in underlying gross premiums,” the report’s authors wrote. “These enrollees will experience a ‘double whammy’ – losing their eligibility for Marketplace premium tax credits and facing the annual increases in the cost of a Marketplace plan.”

The loss of the enhanced tax credit could trigger a spiral that results in even higher premiums for all residents over the long term. 

“If they can’t afford the premiums, they’re not going to rearrange the other costs in their life to make sure they keep health care,” Altman said. “Those are the people we’re going to lose, which means on average we’ll have a less healthy population, which makes premiums higher.”

People who enroll in Covered California to buy insurance through the marketplace are those who don’t have employment where they are offered affordable health benefits. That includes small business owners and their employees and other types of workers.

“Recent data nationally says more than one in four farmers and agricultural workers are on the marketplace in this country,” Altman said. “A lot of them don’t have stable benefits, folks like hairdressers, nail technicians, gig economy workers (or) freelancers. …”

Altman acknowledged that Congress could still act before Jan. 1 to extend the credit, but that could prove confusing to enrollees if it happens after renewal and premium notices go out on Oct. 15. Covered California already established two sets of premium rates, one in case the tax credit is extended, and another if it is allowed to expire.

“If they, say, extend the tax credit in December, of course we will deliver the more generous tax credits and give people that affordability,” she said. “But in the meantime we will have had sticker shock. We will have had families in fear for their ability to maintain their health care, and we will have absolutely lost people from coverage who walked away because of that price change.”

Adding to the ranks of the uninsured

Data released in September 2025 by the U.S. Census Bureau estimates that more than 291,000 residents in the San Joaquin Valley have no form of health insurance at all, whether Medi-Cal, Medicare, Veterans Administration, coverage through an employer or through the Covered California marketplace:

  • Fresno County: 60,517 uninsured, 6% of the county’s population.
  • Kern County: 69,622 uninsured, 7.7% of the population.
  • Kings County: 8,825 uninsured, 6.4% of the population.
  • Madera County: 13,001 uninsured, 8.2% of the population.
  • Merced County: 21,340 uninsured, 7.2% of the population.
  • San Joaquin County: 55,410 uninsured, 6.9% of the population.
  • Stanislaus County: 27,431 uninsured, 5% of the population.
  • Tulare County: 34,996 uninsured, 7.3% of the population.

Of the uninsured in the Valley, almost 102,000 were working in full-time, year-round jobs, while fewer than 61,000 did not work at all.

Statewide, the Census estimates indicate that there are more than 2.3 million uninsured, accounting for 5.9% of California’s population.

In a report issued in September, the independent nonprofit California Health Care Foundation stated that people who have no health insurance are less likely to have a regular doctor or health clinic, are more likely to delay getting care because of cost concerns, experience more preventable hospitalizations, and have poorer overall health.

“After over a decade of expanding coverage and achieving the lowest uninsured rate ever in the state, California now faces the possibility, due to state and federal policy changes, of nearly four million people losing health care coverage,” public health policy researcher and consultant Len Finocchio stated in the CHCF report, referring to federal cuts to Medicaid and state pullbacks to Medi-Cal, combined with the expiration of the enhanced tax credits for subsidized enrollees in Covered California.

“Obviously we know when people don’t have (insurance) coverage, they don’t get the care they need, and that has impacts on them and has impacts on health care costs in the future,” Covered California’s Altman said. “More harsh conditions will come when people don’t get preventive care and all the things that they should get or don’t take the drugs that they need.”

Tim Sheehan is a senior reporter and Health Reporting Fellow with the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.