A Democratic proposal and a Republican alternative addressing ACA subsidies recently failed to pass a Senate vote, something that could be consequential to spine care, Vamsi Kancherla, MD, told Becker’s.
Subsidies are expected to expire at the end of the year. Senate Democrats advocated for a three-year ACA tax credit extension, and Republicans’ alternative focused on health savings accounts.
Dr. Kancherla, of Specialty Orthopedics in Gainesville, Ga., said he is advising patients to review their 2026 coverage and to time procedures before the end of the year if feasible.
He also outlined five key implications if the subsidies expire.
Editor’s note: This response was lightly edited for clarity and length.
Question: What does this mean for spine care over the next 12 months?
Dr. Vamsi Kancherla: If no further legislative action is taken before Jan. 1, we can expect a noticeable impact on patient access to elective spine procedures starting in early 2026.
1. Higher out-of-pocket costs for patients: The enhanced subsidies have made marketplace coverage significantly more affordable for over 22 million Americans, many of whom are in the middle-income bracket without employer-sponsored insurance. Without them, average net premiums are projected to more than double (from around $888 annually in 2025 to around $1,904 in 2026, per KFF estimates), with some facing increases of 75% to 100% or more depending on age, location and income.
2. Shift to higher-deductible plans or loss of coverage: Early enrollment data for 2026 already shows trends toward patients selecting bronze-level or high-deductible plans, or in some cases dropping coverage altogether. This means higher deductibles (often $7,000 or more) and greater cost-sharing before insurance kicks in meaningfully.
3. Deferral of elective spine surgery: Spine procedures — lumbar fusions, decompressions, cervical fusions, etc. — are classic elective surgeries. Patients experiencing chronic back or neck pain often weigh the benefits against out-of-pocket exposure. When premiums rise and deductibles reset in January, many will delay or avoid scheduling these cases to avoid large upfront costs. We’ve seen this pattern historically with insurance disruptions: elective volumes drop as patients prioritize essentials.
4. Volume impact in spine practices: Over the next year, I anticipate a 10% to 20% reduction in elective spine case volume in practices heavily reliant on commercially insured or marketplace patients, particularly in regions with high ACA enrollment. This could be compounded if healthier enrollees drop coverage, leading to adverse selection and further premium pressure.
5. Broader strain on the system: Increased uncompensated care or emergency department visits for unmanaged pain could indirectly affect hospital resources, though the primary hit will be to surgical throughput.
