CASE STUDY: Sample Middle-Class WA Couple Facing $880 -$1,325 Monthly Health Insurance Premium Increase Across All 39 Counties

Sample ACA exchange user in Washington state will have to pay over $12K more for same healthcare coverage in 2026

WASHINGTON, D.C. – Today, U.S. Senator Maria Cantwell (D-WA), ranking member of the Senate Committee on Commerce, Science, and Transportation and senior member of the Senate Finance Committee, released a case study showing the actual, shocking increase in health premiums for a sample middle-class family across all 39 WA counties, due to the expiration of Affordable Care Act Enhanced Premium Tax Credits (ePTCs).

• The sample family: A married couple, the man aged 60 and the woman aged 55, with a household income of $120,000/year, who purchase health insurance on the ACA marketplace exchange.
• Using WA Healthplanfinder’s estimate tool, prices were generated for the least expensive 2025 plan in each county that is still available in that county in 2026.
• The average increase across all 39 WA counties is $1,049/month or $12,590/year.
• For example, this case study found that the sample couple would see their monthly premium increase by $960/month if they live in King County; $991/month if they live in Spokane County; and a whopping $1,097/month if they live in Clark County.

Health insurance premiums vary based on the age and gender of a family’s members, the family’s total household income, and the county where they live. The sample middle-class family in the case study would have been eligible for an ePTC in 2025, but would not be in 2026.

County-by-county data is in the table below, sorted alphabetically by county.

At 12 a.m. on Oct. 1, the deadline for Congress to pass a new budget bill expired, triggering a federal government shutdown. Republican lawmakers refused to negotiate with Democrats on extending the Enhanced Premium Tax Credits (ePTCs) under the Affordable Care Act (ACA) – the primary request of Democrats that would help reverse healthcare costs set to spike due to policy choices made in President Donald Trump’s Big Ugly Bill – and fell short of the 60 votes needed to pass a new budget. Unless Congress acts urgently, Americans who purchase coverage on the open market will end up locked into new unaffordable rates in 2026. For nearly all states, the open enrollment period begins on Nov. 1 (with the exception of Idaho, which began on Oct. 15).

Sen. Cantwell, who serves as a senior member of the Senate Finance Committee and ranking member of the Senate Committee on Commerce, Science, and Transportation, delivered a speech on the Senate floor taking her Republican colleagues to task.

“You have no ideas on how you are going to help keep people insured, or keep these hospitals operating. So instead of meaningful negotiations, my colleagues have decided they don't want to tell us what their ideas are to deal with the current crisis. It is not a next year problem, it is a today problem,” Sen. Cantwell said in her Oct. 1 speech.

Video of that speech is available HERE; a transcript is HERE.

Last week, Sen. Cantwell released a county-by-county breakdown of how many people eligible for the credits live in each county and how many of those people received ePTC in 2025 as both a raw number and a percentage of the under-age-65 county population. The breakdown also included an average expected increase. The data released today shows the real-dollar impact to a sample family in each of Washington’s 39 counties.

Said Sen. Cantwell upon release of that report: “Congress has less than two weeks to act before Washingtonians and beneficiaries in most other states lock in these sky-high premium rates after open enrollment on November 1st. I'm fighting to block these ruinous price hikes -- the time to come to the table and find a solution is now.”

Last month, Sen. Cantwell released a snapshot report detailing the drastic increase in how much Americans who purchase health insurance on the open market will pay next year. The snapshot report, which included information on premium increases across all 50 states and the District of Columbia, found that the health insurance companies with the largest market share in 29 states will or propose to charge at least 20% more per month for care – further squeezing Americans already facing an affordability crisis. Health premiums typically rise every year, but this year’s increases are expected to be much larger than last year’s. This report found that in 20 states, the state's top exchange plan insurer is requesting, or has already been granted, a rate increase for 2026 that’s at least 20 percentage points higher than the rate change that same insurer was approved for in 2025.

READ MORE: The Spokesman-Review: With government shutdown imminent, Cantwell highlights Democrats’ key demand: Stopping sharp increase in health insurance costs

Sen. Cantwell also sent a letter to President Donald Trump, Senate Majority Leader John Thune, Senate Minority Leader Chuck Schumer, Speaker of the House Mike Johnson, and House Democratic Leader Hakeem Jeffries last week urging them to act before the open enrollment period begins.

The full snapshot report is available HERE; the full text of Sen. Cantwell’s letter to President Trump and Congressional leadership is HERE.

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