Obamacare health insurance premiums are going up as enrollments are dropping for the first time in five years, and those two factors mean it’s time for Congress and President Donald Trump to enact new measures to expand the availability of Health Savings Accounts (HSA) and incorporate faith-based health care sharing operations, say experts.

“Families are facing growing pressure from rising premiums, higher deductibles, and increasing uncertainty about what they can afford,” said Randall Hultgren, executive director of the Alliance of Health Care Sharing Ministries (HCSMs). “Health Care Sharing Ministries offer an escape from the insurance trap. HCSMs are a faith-centered approach to health care that allows members an affordable, responsible, and caring alternative to insurance. Members share one another’s medical burdens while maintaining greater control over their health care decisions.”

The increasing health care costs Hultgren mentioned are linked to the Affordable Care Act’s establishment of the Obamacare health insurance complex in 2011 and the fact that insurance premiums in the massive government program are rapidly increasing and enrollments are decreasing.

“Enrollment in the Affordable Care Act continues to erode as some customers struggle to make premium payments, with the declining numbers churning market uncertainty for insurers. In response, insurers are likely to raise rates again next year, following this year’s larger-than-typical hikes,” KFF Health News reports. The KFF Health News is published by the nonprofit formerly known as the Kaiser Family Foundation. The publication is not linked to the Kaiser Permanente health insurance giant.

“Sign-ups were already down in January by about 1.2 million from last year’s record enrollment. For this year, enrollees then faced premiums that increased, on average, by 26%. On top of that, subsidies that help people purchase coverage shrank or vanished. Now experts are watching how many of the approximately 23 million people who enrolled will fail to pay their share of premiums,” the KKF report added.

Those declining enrollment numbers and higher premium costs are not coming as a surprise. Temporary premium subsidies approved by Congress and then-President Joe Biden during the latter stages of the COVID pandemic in 2021 helped minimize premium increases at a time when the economy suffered record-high inflation rates. The premium subsidies accomplished two things, spurring a five-year run of artificially increasing enrollment in Obamacare insurance offerings and pouring billions of tax dollars into major insurers’ coffers.

But the premium subsidies were terminated at the end of 2025 as a result of a provision of the One Big Beautiful Bill (OBBB) Act pushed by Trump and congressional Republicans. Trump and the GOP argued the premium subsidies created a false image of Obamacare affordability and, they insisted, the program must not be what consumers want and need if it depends upon government support to stay afloat. Ending the subsidies prompted congressional Democrats to oppose the OBBB because, they predicted, it would result in higher premiums and declining enrollments. Instead of canceling the subsidies, the Democrats argued for making them permanent.

As The Washington Stand reported last year, the premium subsidies were a gold mine for the biggest health insurance companies participating in Obamacare. Ending the subsidies meant huge financial losses for the companies. A measure of just how serious the companies viewed the threatened stopping of the subsidies is, as TWS also reported, the insurance titans dispatched millions of dollars of campaign contributions to Democrats in Congress and state legislatures.

A great part of the estimated $27 billion of income received in 2025 by the insurance firms was linked to a huge surge in false enrollments from subsidy payments made in response to filings under false names. “The Biden COVID Credits are paid directly to health insurance companies from the U.S. Treasury. Since the funds do not go to individuals, millions of people have been fraudulently enrolled and often do not even know that they have been signed up. About 40 percent of people who are fully subsidized by Biden’s COVID Credits did not make a single claim for a medical procedure or medication in 2024,” Economic Policy Innovation Center (EPIC) Researcher Gudai Bulgac reported last October.

And at least one major player in the Obamacare health care insurance realm, Oscar Health, likely would not be in business due to its dependence on the subsidies because in 2024, 97% of its revenues came from the federal subsidies, according to Bulgac. “More than nine-tenths of that revenue was subsidized by the federal government, including Biden’s COVID credits, totaling $9.5 billion in 2024, a dramatic increase from $2.5 billion in revenue from taxpayers in 2021. That is $9.5 billion in direct payments from the federal government” to a single company in a single year.

Multiple Democrats in Congress received campaign contributions from Obamacare health care corporations, with Senate Minority Leader Chuck Schumer (D-N.Y.) getting funds from four such firms. As TWS reported last October, Schumer’s Impact leadership PAC received $271,284 in contributions from Minnesota-based UnitedHealth Group and the St. Louis-based Centene, two of the 10 biggest health care insurance firms that depend on Obamacare for significant portions of their annual revenue.

The Schumer PAC received an additional $78,024 from Indianapolis-based Elevance, which was formerly known as Anthem, as well as $49,024 from Rhode Island-based CVS Health. That brings the Schumer PAC’s total haul for the period 2019 to 2024 to $398,332. Each of these four firms is among the 10 biggest health care insurance firms in the Obamacare universe, as ranked by Venteur.

With congressional GOP leadership considering a push for a reconciliation 3.0 proposal in the coming months, strategists with the Alliance of Health Care Sharing Ministries see an opportunity to increase the utility and visibility of Health Savings Accounts (HSA). The HSAs enable employees to set aside a certain portion of income that is tax-free — as long as it’s spent on medical expenses.

“As Congress considers a third reconciliation package, supporters say expanding HSA eligibility would increase consumer choice, portability and affordability while giving families greater control over health care spending through tax-advantaged savings options,” the alliance said in a statement obtained by TWS.

The just-passed Reconciliation 2.0 bill provided more than $70 billion in funding for the Department of Homeland Security (DHS) following Democrats’ 76-day refusal to support appropriations for two DHS components that are critical to its mission, including the Customs and Border Protection (CBP) and the Immigration and Customs Enforcement (ICE) agencies, both of which are crucial to the success of Trump’s border security strategies to stop and reverse the massive illegal immigration into the U.S. under his predecessor in the Oval Office.

The reconciliation provision of the legislative process allows the Senate to approve legislation with a simple majority of 51 rather than the usual requirement of 60 votes. With Republicans holding only a 53-47 majority, using the reconciliation process has proven to be the only way major legislation favored by Trump and his Capitol Hill allies can be approved, thanks to the refusal of any Senate Democrats to compromise. The provision was originally conceived as a tool only for passing critically needed spending measures, but the Senate parliamentarian has, in recent years, allowed consideration of proposals with limited provisions that are not strictly to authorize spending.

Hultgren told TWS that his organization “took the bold step of joining the Great American Health Alliance (GAHA) earlier this year with its primary goal of expanding access to practical, affordable wellness options, including and especially Health Savings Accounts (HSAs).”

“Currently, HSAs are restricted to high-deductible catastrophic plans,” he continued. “This legislative proposal [the Great Health Care Plan outlined by Trump] will make Health Care Sharing Ministries HSA-eligible by folding them into existing bronze/catastrophic HSA qualification provisions under the ACA framework. In reconciliation 3.0, Congress has the perfect vehicle to ensure HSA fairness for all Americans by including the appropriate provisions that recognize eligibility for members of Health Care Sharing Ministries to participate in HSAs.”

The GAHA points to two provisions of the Trump vision that apply to HSAs. The first “decouples [HSAs] from high-deductible plans to provide all Americans with liquid, tax-free, consumer-managed funds,” while the second “expands HSA-eligible expenses to prioritize longevity through prevention, fitness, and screening.”