Residents of Buncombe County, North Carolina, are facing a significant increase in Affordable Care Act (ACA) insurance premiums for 2026. Many are now reconsidering their health coverage options. Virginia Gilbert, a 63-year-old self-employed therapist from Asheville, is one example. Her monthly premium is expected to rise from $930 to $2,042, which is nearly equal to her mortgage payment. This increase follows the end of a six-week government shutdown by the U.S. Senate, which did not extend enhanced premium tax credits. As a result, policyholders may not receive continued financial assistance.
According to Nicholas Riggs, director of the NC ACA Navigator Consortium at Legal Aid of North Carolina, nearly 32,000 Buncombe County residents and 975,000 North Carolinians are enrolled in ACA-backed plans. The nonprofit KFF estimates an average 114% increase in ACA plan costs across the state. Western North Carolina, including Asheville, is expected to see even higher premiums—about 15% more than cities like Raleigh. This is partly due to limited competition among healthcare providers, especially the presence of HCA Healthcare-owned Mission Health.
The end of enhanced subsidies, which were expanded under the 2021 American Rescue Plan Act (ARPA), is a key factor. These subsidies had increased eligibility and lowered premium caps. Their future is uncertain after being left out of recent federal budget agreements. The July 2025 One Big Beautiful Bill Act also removed enhanced tax credits for some legal immigrants, including DACA recipients…