By David Olson

Updated November 1, 2025 9:43

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Long Islanders signing up for health insurance through the Affordable Care Act beginning Saturday may suffer sticker shock, with some monthly premiums reaching thousands of dollars and no sign of an agreement on extending federal subsidies in sight.

Open enrollment on the New York State Department of Health’s ACA marketplace begins Nov. 1 for new enrollees and Nov. 16 for renewals.

About 28,000 Long Islanders currently receive a federal tax credit to help pay for their insurance. A 2021 law increased the amount of government assistance, but those enhanced subsidies are set to expire Dec. 31. Small-business owners and employees and independent contractors are among those who have ACA insurance.

If the subsidies are not extended, “The choice people will be making is between health insurance and groceries, or health insurance and their mortgage,” said Vanessa Baird-Streeter, president and CEO of the nonprofit Health and Welfare Council of Long Island, which assists people with signing up for the ACA.

“People are very much worried” about losing coverage, said Baird-Streeter, including middle-income people who struggle to afford insurance on high-cost Long Island.

Democrats have refused to vote for a government spending bill unless the enhanced subsidies are made permanent. That has kept the government shut down since Oct. 1. Some Republicans oppose extending the subsidies while others say the issue should be resolved outside the shutdown.

Even if subsidies eventually are extended, Cynthia Cox, director of the ACA program for the nonprofit health policy group KFF, worries that many people will take one look at high premiums and not give the ACA another chance.

“Once a person decides something is too expensive, it takes a lot of convincing to get them to come back look again,” she said.

Anyone signing up for new ACA coverage can find out starting Saturday how much they’ll pay without subsidies.

New Yorkers currently with ACA coverage can get estimates for how much their subsidies will decrease, but it won’t be until renewals begin on Nov. 16 that they will see exactly what their new policies would cost, Cassaundra Howell, chief operating officer of the nonprofit Public Health Solutions, said in an email.

The average premium increase for Long Islanders with subsidized plans would be 32%, the state estimates.

A KFF online calculator shows that a family of four in Suffolk with an annual household income of $130,000 would, if the subsidies are extended, receive an estimated monthly federal tax credit of $1,514. That would mean an estimated premium for a mid-tier “silver plan” would cost $921 a month. But they would be ineligible for any government help if the enhanced subsidies are not extended and would instead pay an estimated $2,435 monthly premium.

An individual in Nassau earning $45,000 a year has a low enough income to still qualify for subsidies even if the enhanced credits aren’t extended. But the cost for a silver plan would rise from $206 a month to $359. That person currently pays a $0 premium for a bronze plan and would pay $143 if subsidies are not extended. Bronze plans, though, have higher deductibles and co-pays.

Rep. Laura Gillen (D-Rockville Centre) said in a statement that she has “heard from many Nassau County residents concerned that their premiums are set to skyrocket. … [Republicans'] refusal to extend these credits, which only legal residents are eligible for, will worsen the cost-of-living crisis on Long Island. I will continue fighting for both sides to work together to preserve these tax credits.”

Rep. Nick LaLota (R-Amityville) supports extending the subsidies for a year but has called on the shutdown to end.

“Americans need real solutions to rising health care costs, as since the enactment of Obamacare, premiums have grown 60% faster than inflation even while one in three claims are denied and insurance companies post record profits,” he said in a statement.

The drop in subsidies could be deadly for some, Michael Davoli, New York senior government relations director for the American Cancer Society’s Cancer Action Network, said in a statement.

“These increases will put quality, affordable coverage out of reach for many New Yorkers,” he said. “For cancer patients in active treatment and who may face a cancer diagnosis in the future, a loss of coverage would be life-threatening.”