If federal subsidies for marketplace health insurance plans expire at the end of the year, Idahoans on the most “vulnerable fringes” will feel the effects first, Idaho state Rep. Ilana Rubel, a Boise Democrat, said Tuesday.

But it won’t be long until the loss of those subsidies, which keep insurance premiums low for people on Affordable Care Act marketplace insurance plans, “hits every single person in the state,” she said at a protest organized by Ada County Democrats.

Without the subsidies, monthly premiums are expected to more than double for many plans, the Kaiser Family Foundation found. If marketplace premiums dramatically increase without federal subsidies, more people will likely choose to go uninsured — a serious problem for hospitals, which rely on people with private insurance plans to pay the bills, Rubel said.

“When you pull out people’s private insurance, you make it impossible for hospitals and providers to operate profitably,” Rubel said. “You can be the richest person in the state with fabulous insurance, but if a hospital in your area has gone out of business, and you have a heart attack, you are out of luck.”

Idaho’s open enrollment period closed Monday — the first marketplace in the country to do so. At Tuesday’s protest, held outside the Boise office of U.S. Sen. Jim Risch in protest of Congressional Republicans’ “inaction” on reinstating the subsidies, Ada County Democrats Chair Jared DeLoof said Idaho would be “ground zero for a national health care affordability crisis.”

Madison Hardy, a spokesperson for Risch, did not immediately respond to a request for comment.

“People do die from a lack of health care. People do die from a lack of health insurance,” Rubel said. “Unfortunately, we are going to be Exhibit A for that shortly.”

Her predictions were echoed by leaders of Your Health Idaho, the state’s official health insurance marketplace. Of the 115,000 Idaho residents who rely on marketplace plans, the marketplace expects 25,000 to cancel their coverage as plans become more expensive, said Nichol Lapierre, its chief marketing officer.

But initial data from Your Health Idaho painted a more murky picture of residents’ decisions. Twice as many Idaho residents canceled their existing marketplace coverage as during open enrollment last year, Lapierre said — but there were also more people who enrolled in new plans, leading to a 4% increase in the number of people enrolled overall.

Though Your Health Idaho is “encouraged” by the overall increase in enrollment, Executive Director Pat Kelly said, he highlighted a nearly 10% shift from “gold” and “silver” plans that cover almost all health care costs to “bronze” plans that have lower premiums but much higher deductibles and other costs.

Around 5,000 customers have canceled plans for the upcoming year because of concerns about affordability, according to Your Health Idaho, and the marketplace anticipates more cancellations in the coming months. If premiums spike in early 2026, Your Health Idaho expects another 20,000 Idaho residents to cancel their coverage or be terminated by their insurance carriers for nonpayment.

“The final enrollment numbers won’t settle until April,” Lapierre said.

DeLoof emphasized that these marketplace plans are not “handouts,” but rather the plans used by small business owners, self-employed workers and farmers.

Though those people make too much to qualify for Medicaid, they “cannot absorb the massive premium hikes that are coming their way,” he said Tuesday. “Working families are being squeezed from every direction.”

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Becca Savransky contributed reporting.

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