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Arizona small business owners are making difficult decisions about health insurance coverage since Affordable Care Act premium subsidies expired at the end of 2025 and their monthly costs spiked.

About 245,000 Arizona residents received those health insurance premium tax credits last year, more than 90 percent of them federal marketplace enrollees.

So far this year, the end of the premium subsidies and sharply higher costs have prompted more than 70,000 fewer Arizonans to enroll in the federal marketplace.

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Phoenix area Realtor Michelle Jernigan, a married mother of five, said she had to buckle down to afford health care this year after her plan was no longer available on the marketplace.

"Our costs now have gone up to $1,700 a month for our family," said Jernigan. "So, we've seen an increase of $700 monthly."

The U.S. House passed a bill to extend the premium subsidies at the end of last year, and the Senate was considering taking it up in January. But to date, that hasn't happened.

The Trump administration has said those subsidies were designed to help people get through the financial crisis caused by the COVID pandemic and were never intended to be permanent.

Jernigan said like other Arizona small business owners and families, she's having to make tough decisions about what to buy and what to skip. But she said she thinks there is a financial trickle-down effect that doesn't stop at home.

"I was born and raised in Arizona and built a business here, and have poured back into my local community," said Jernigan. "I feel like what that has done has made me consider, you know, not spending as much – which I think impacts our communities, right?"

KFF Health, a nonpartisan health policy research group, estimates the end of subsidies caused insurance premiums to double, on average, for those who signed up for coverage on the marketplace in 2026.