In early February, Lauren Jenkins, CEO of Native Oklahoma Insurance in Coweta, clicked through a website her family-owned agency uses to enroll thousands of clients in health insurance. The agency specializes in helping tribal members, but can assist anyone.
Jenkins entered different incomes and ages to review the options people have for coverage through the Affordable Care Act Marketplace.
It was during meetings like this that many Oklahomans learned their premiums were surging amid rising health care costs and the expiration of enhanced premium tax credits. For example, one of the cheapest options for a 60-year-old making $70,000 costs over $1,000 a month, Jenkins said.
Approximately 97% of Oklahomans on the Marketplace benefited from premium tax credits in 2025, which were enhanced under the American Rescue Plan Act during the pandemic. The enhancements were extended through the end of last year via the Inflation Reduction Act.
These enhancements provided additional assistance to those already eligible for the regular tax credits and expanded eligibility to enrollees with incomes above 400% of the federal poverty level (FPL). They resulted in record Marketplace enrollment through last year.
But when it came time to address the enhancements' sunset, a debate ensued among federal lawmakers, fueling the longest government shutdown in history. When no deal was reached to extend them, and conversations fizzled out, people were left to pay a larger share of their health coverage. Those with incomes over 400% of the FPL had to pay full price.
"People feel like they got that rug ripped out from underneath them. And they would have expected to have an alternative or something that would have softened the blow a little bit," Jenkins said. "And that just didn't happen."
This year, nearly 50,000 fewer Oklahomans selected a Marketplace plan compared to last year, and even more are expected to drop out amid higher costs. Consumers are now navigating the consequences of this expiration with limited choices.
How one Oklahoman is handling a 109% jump in his premium
Brian Black, 60, lives in Midwest City. He has been a "solopreneur" since May 2024, when he started his own business as a human resources consultant.
Marketplace plans are put in four metal levels: bronze, silver, gold and platinum. For 2025 coverage, Black selected a high-deductible bronze plan with a $475 monthly premium.
Black said he's pretty healthy. He visits his doctor twice a year and takes a couple of low-cost maintenance medications.
He said his plan didn't have all the bells and whistles, but in some ways it was better than the previous coverage he had through his employer.
But his income, combined with his wife's, went over the returning limit. That means this year, he would have had to pay full price for the same plan at $995 per month. He said he felt like that was unacceptable.
"Here I am trying to build a business," Black said. "And from a government perspective, they talk about, 'We want to empower small businesses, we want to give them everything they need to survive, to thrive, to be successful,' and then you go and just rip the rug right out from under us on health care."
Consumers do have some cheaper options, but they come with trade-offs. The one Black chose is called a health sharing plan, which he found through MPB Health. It isn't insurance.
It's a group whose members have a common set of ethical or religious beliefs and share each other's medical expenses. Many are faith-based and called health care sharing ministries, although Black's isn't.
Black pays about $300 a month, and he can participate in a health savings account. If he had an incident, he would normally be responsible for a certain amount, called an "initial unshareable amount," before the sharing kicks in. But Black pays an additional $20 per month instead of being responsible for an initial unshareable amount.
But the groups can choose not to share patients' bills and aren't subject to regulation by state insurance commissioners. Black said he recognizes those downsides.
"I'm fortunate. Because I am in good health, I can move to something like a health sharing option. I know there are a lot of people who can't. And I feel for them because they don't have that option," Black said. "And it's unfortunate because I feel like our government should be doing more to help our people."
What other options do Oklahomans have?
State Insurance Commissioner Glen Mulready said he sent letters to state leadership last March, highlighting the ripple effects this expiration would have on Oklahoma's health care system. He met with federal lawmakers in May. Mulready advocated for measures like an income cap on the enhanced premium tax credits and expanding consumer choice.
These efforts, he said, yielded little traction.
Mulready said he agrees with the enhancements being temporary assistance that were "critically important" during the pandemic to ensure people had health coverage.
"I have disagreed with how they're ending and not having a – I always called it a 'glide path,' but just a few-year glide path versus a cliff," Mulready said.
Federal lawmakers did expand eligibility for catastrophic plans to people who lost their tax credits. They are ACA-compliant and have lower premiums, but deductibles can be $10,600 for an individual and $21,200 for a family. Both bronze and catastrophic plans now work with health savings accounts.
Oklahomans could also choose short-term limited-duration insurance, which was designed for people experiencing a temporary gap in coverage. It was limited to three months, with a one-month renewal under the Biden administration.
But the Trump administration allowed states to apply their own definitions to the coverage without facing federal penalties. Oklahoma is currently allowing them for up to a year, with room for extensions and renewals for a total duration of up to three years.
The plans often have cheaper premiums, but they aren't ACA-compliant, meaning they can exclude coverage for pre-existing conditions and aren't required to cover essential health benefits, like preventive care and prescription drugs.
Healthinsurance.org health policy analyst Louise Norris said certain data won't be available until later this year, including the demographics, income and metal levels for people who selected or automatically renewed into a plan, and how many people who enrolled in coverage actually paid their premiums.
Some data is available in states with state-run Marketplaces, which offer some clues as to what people might be doing. Currently, Oklahoma relies on the federal government for its Marketplace, but it intends to transition to a state-based exchange for 2028 open enrollment.
Norris said in New Jersey, enrollment in bronze plans increased by 57%, and in California, bronze and catastrophic plan enrollment increased by 23%.
"Those are some examples of state-run marketplaces where they were taking some action to try to offset these losses with state money, but they're still seeing pretty significant shifting of people buying cheaper plans or canceling their coverage altogether," Norris said. "So, I would expect that once we have data for Healthcare.gov here in another few months, we will probably see something similar."
Enrollment numbers for non-ACA-compliant options are not tracked as closely, Norris said.
"So we may never know actual real numbers of how many people actually shifted to these different plans just because it's very hit or miss in terms of whether we get that data," Norris said.
'Fixing the root of the problem'
Norris said, although negotiations seem stagnant now, she thinks the enhanced premium tax credits might become a policy issue again later – especially because it is a midterm year.
Julie McKone, the executive director of Oklahoma Families for Affordable Healthcare, said health care affordability is a critical concern for Oklahomans. The group has been advocating for the enhanced tax credits to be extended and highlighting stories from Oklahomans who were concerned about their expiration.
In a recent survey of more than 1,300 Oklahomans commissioned by Altarum's Healthcare Value Hub, 72% of Oklahomans said they experienced at least one health care affordability burden in the past year. More than two-thirds said they or a family member skipped or delayed medical care due to cost.
"We know that with the tax credit issue, people are losing coverage, people are paying higher premiums, they can't afford to pay those premiums, so they might forgo that," McKone said. "The fewer people we have enrolled in insurance, the higher the premiums will be for everyone."
Insurance professional Lauren Jenkins said if she had a magic wand, she would want to see solutions put in place that address costs and create choice for consumers. That requires time.
Temporarily expanding the enhanced tax credits is a band-aid, she said.
"But we also need to put the antibiotic on the wound – not just leaving it uncared for but fixing the root of the problem while also providing a surface solution," Jenkins said.
