A record-breaking 21.4 million Americans enrolled in Affordable Care Act (ACA) health insurance plans in 2024, including 22,170 enrolled via the Hawaii Marketplace. Additional federal subsidies approved during outgoing President Joe Biden’s term drew new enrollees. However, if a Republican-controlled Congress blocks renewal of the subsidies, which expire this year, millions of Americans would become uninsured, unable to afford premiums, Biden warned.

On Wednesday, he called on Congress to “double down on the progress we have made.” But it’s far from clear that there’ll be an extension, and otherwise, the Congressional Budget Office forecasts that premiums will spike.