Langworthy Brushes Off Thousands Facing Premium Spikes

During Rep. Nick Langworthy’s November telephone town hall, a caller named Randy raised concerns about exploding health insurance costs. The transcript of that exchange is included at the end of this post.

For Randy, the call provided an opportunity to discuss the Affordable Care Act. His family pays out-of-pocket for Fidelis insurance, which is $5,000 cheaper than alternatives like Excellus, but even that option is becoming difficult to manage. “We’re kind of stuck between a rock and a hard place,” he said.

Rep. Nick Langworthy responded with “I’m sorry you’re going through this,” then reviewed how the Affordable Care Act has not met its original promises on costs. He cited insurance company profits, subsidies directed to insurers, and limited controls on premiums. He described the expiring enhanced premium tax credits as affecting “only 7/10th of 1%” of constituents in his district. “This wasn’t a prolific situation for our community,” he said.

“Yeah. I’m sorry you’re going through this. I mean, in what you pointed out is it at the outset, this is not affordable.”

Rep. Nick Langworthy

ACA Subsidy Expiration Effects on Coverage

The enhanced premium tax credits, introduced under the American Rescue Plan Act in 2021 and extended through the Inflation Reduction Act until the end of 2025, have supported access to health insurance for millions. These credits removed income caps and limited premiums to no more than 8.5% of household income for eligible families. Nationwide, they assist around 24 million enrollees in ACA marketplaces.

Without congressional action, the enhanced credits expire on December 31, 2025. According to the Kaiser Family Foundation, average premium payments for subsidized enrollees could more than double.

In New York, premium increases have already been approved, averaging 7% for individuals and 13% for small groups in 2025, per the NYS Department of Financial Services. The loss of federal enhanced subsidies will lead to even higher premiums.

For example, in Western New York, a family of four earning $66,000 – 205% of the federal poverty level – could see monthly premiums rise from $121 to $373 – more than $250 a month, adding nearly $3,000 annually. Households just above certain income thresholds might face increases of $5,000 to $10,000 per year.

In his NY-23 district, Langworthy said during his telephone town hall that 0.7% of constituents in NY23 benefit from the premium subsidies. With a district population of approximately 777,000, this equates to roughly 5,000 people, consistent with estimates from groups like Keep Americans Covered. 

Langworthy’s Comments 

During the telephone town hall (transcript below), Langworthy discussed subsidies flowing to insurance companies, lack of equity in the system, delays in pre-authorizations, and the need for controls. He mentioned health savings accounts, guardrails on profits, and anticipated a Trump administration proposal. As of mid-December 2025, House Republicans released a health care package that does not extend the enhanced subsidies, focusing instead on measures like association health plans and pharmacy benefit manager reforms. A Trump-backed framework for a temporary extension faced internal GOP opposition and has not advanced.

Langworthy has voted against measures to expand the Affordable Care Act in the past. For example, he voted against capping the cost of insulin. And he’s supported Republican Party proposals to decrease or eliminate the Affordable Care Act.  

In 2017, a full repeal attempt narrowly failed. Subsequent actions included reducing enrollment outreach and shortening enrollment periods, contributing to reductions in the number of people enrolled in the ACA.  In response to changes in the ACA, New York began its Essential Plan which covers 1.6 million low-income residents.

NY-23 District

In NY-23, a solidly Republican district rated R+12 by Cook Political Report, the median household income is around $71,000. That’s not enough to pay for thousands in additional health insurance premiums. People are going to go without health insurance because they can’t afford it. 

Public Opinion

Polls show broad support for maintaining affordable coverage. A Siena College survey found 78% of New Yorkers favor extending the ACA subsidies, including 62% of Republicans. Nationally, around 70% of people oppose ending the subsidies.

As of December 17th, 2025, congressional efforts to extend the ACA subsidies have stalled. The Senate vote failed in the face of Republican opposition. The Speaker of the House refused to bring the proposal to the floor for a vote. But like the Epstein Transparency Act, there is a discharge petition that has gained the necessary 218 votes to force a House vote, including four Republicans. But with thousands of people in the NY-23 potentially impacted, families will face much higher premiums in 2026.

Transcript from Langworthy’s November Telephone Town Hall

Langworthy: Next, we're going to talk to Randy.

Randy: Hi, Congressman. Thanks for having this conference call. This is the first time I've been on, so thank you very much.

Langworthy: Well, great. Where are you calling from tonight, Randy?

Randy: My wife and I, we live in Bath in Steuben County.

Langworthy: Wonderful. Great to have you with us.

Randy: Hey, thanks. So, my question is, we were notified by our health insurance company, which we pay for out of pocket, because my wife and I, we work for different employers with less than 50 employees, and we had Obamacare jammed down our throats many years ago and we can't really get out.

Langworthy: You've been on the Obamacare exchange since it pretty much started.

Randy: Yes. And so, we're going to be entering the working poor class because our rates are going to go up to about $25,000 per year, because it's not just myself and my wife, but because of the law, we're forced to pay for our daughter's health insurance until she's 26. And she is currently 21. So, this is basically going to nullify my wife's income.

Langworthy: So, so you're forced to hold your daughter on there. Obviously some people find it is very helpful.

Randy: But if you're forced to, pretty much is what we were told, is whatever that law even if she has employer based coverage,

She is a student. She's doing her masters over at SUNY Albany for library science.

Langworthy: Gotcha.

Randy: So not only, you know, do we have the health insurance going up, but we're also paying her student loan. She went to Keuka College, so that was our gift to her. So, you know, I mean, and we live within our means. We are pretty frugal with our spending, but this increase in the quote unquote Affordable Care Act is not. It's unaffordable care act is what it really is. We pay for Fidelis insurance out of pocket. And it's kind of funny, you know. Some people get Fidelis for free. So, you can be at your doctor's office and, you know, someone has Fidelis that, you know, isn't working or whatever and they get everything for free. Though those of us that work, we pay out of pocket and then some. And some businesses don't accept Fidelis, but you know, it was, you know, $5,000 cheaper than taking Excellus.

Langworthy: Sure.

Randy: So, we're kind of stuck. And I just like to know although, you know, my job situation may change within the next six months. I'm hoping to work for the state and then I can get on decent insurance. But at 53 years old and my wife is 55, we're, you know, we're kind of stuck between a rock and a hard place.

Langworthy: Yeah. I'm sorry you're going through this. I mean, in what you pointed out at the outset, this is not affordable. I mean, Obamacare was supposed to, you know, what was the promise? It was everyone's going to have access. It's going to drive down the cost for everyone. Things are going to go down. It's going to be easy. If you like what you have, you can keep what you have. It was going to be all things to all people.

And what have we seen? What have we seen all these years later? I mean, now we're at the cliff on Obamacare where there's hellish amounts of money going into the subsidies. There's obviously this COVID era cliff. This COVID era 5-year enhanced premium tax credit that is expiring.

And you know, people had something for 5 years, and they think that's just, you know, that that is going to be forever. This was designed as a COVID relief program. And that's the biggest problem we have here is that costs have actually exploded on the premiums. And all the money, all this government money goes directly to the insurance companies. The only thing that has exploded other than your premium costs are the profits of the insurance companies during COVID because there's no controls on how high these premiums go.

Some people have a zero financial commitment to it. Some people that are on the bubble of it like you're on, are paying through the nose for insurance they don't probably like all that much.

And you know we have to have a discussion about the future of all of it as to how to again reign in the costs, Reign in the profits of these insurance companies because they've been allowed to run amuck. I mean they frankly have no controls. And us shoveling more government money at them is not going to make them behave better. It's going to actually take it the wrong direction. you know. We're hearing more and more from people whether you're on private insurance or you're an employer that's providing insurance from their employees, how out of control the premiums are getting.

And you know, we want to see as many people covered as possible, but you can't have this world where a whole bunch of people pay nothing, and then everybody else gets sucked hard because there's just there's no equity in that whatsoever.

You know, I think the president, he kind of held back the announcement because there was a lot of Republican disagreement, but he said he's going to start with a proposal that he'll roll out probably next week to try to get a way out of some of this.

I mean, because we're right in for another brinksmanship for the January 30th deadline on the enhanced premium tax credits and everything that goes along with that.

Now, I checked in early on this enhanced premium tax credits, and I pulled the numbers for our district. There's only 7/10th of 1% of our constituents that actually get the enhanced premium tax credits. So you know, this wasn't a prolific, you know, situation for our community, as the other side was really trying to portray it to be.

But, you know, I'm hearing from more and more people in your shoes where just the annual premium having nothing to do with the enhanced premium tax credit is just unaffordable at this point. And it's, you know, you need to have insurance. Obamacare is your only option, but there's got to be some price controls in here. We've got to in and look at putting everything on the table from health savings accounts, you know, and take the power out of the hands of the insurance companies here. And probably put some really hard guard rails around them because they're providing massive profits to their shareholders in poorer care every single year to people.

I mean, the things I'm hearing from people on pre-authorizations, on how long it's taking to get their procedures authorized. It's unacceptable.

So, we we've got a long way to go. We have to dig in on this. We are going to have to have bipartisan compromise. I mean, let me give you let me give you an example.

Randy: Sorry to interrupt you, but something you can dig into is. I'm not going to tell you where this was. It really doesn't matter. But a good friend of mine asked me, he said, "Hey, I need a big favor. Can you bring me to the hospital?" And he was having he's having heart troubles. Okay. So, I said, "Of course I will."

I brought him to this certain hospital. And this hospital is very friendly with the local fire department. And the hospital was encouraging a transfer. Okay. So, these paid for fire departments are, I don't want to say they have quotas, but they are encouraged by the mayor of the city to get as many transfers from the hospital over to Rochester. So that's how the city makes their money is on transfers. And then who pays for that? The health insurance companies. And then the patient gets stuck with a $6,000 transfer fee. So I asked, I said, "Hey, ask your doctor if you're well enough for me to bring you up to Strong." And it was like I don't want to say it was a battle, but they said four times, "Oh, you really should take a transfer”. You know, which means because they get a big reimbursement on that ambulance ride."

Langworthy: Exactly. There's too many games being played. It's games that are being played by local government and good old boy’s organizations out here in Stueben County.

Well, there's there there's an awful lot of that going on and you know, I take a ton of meetings on healthcare because I'm on the Energy and Commerce Committee and it's our jurisdiction and every time whoever the stakeholder is leaves a room, I turn to my staffer and I say, "So, who's the villain of the story as to why the prices are out of control?"

You know, the hospital points to the insurance company, the insurance company points to the pharmaceutical industry, the pharmaceutical industry points to the insurance company, and on and on and on. And it's this, but you know, they're all growing profits. It's the people that really aren't being served well. And no, Obamacare has set the table for them to have this power and control. And that's what we have got to make fixes. You're not going to repeal it. We've got to make fixes to the system within it. And it starts with people sitting around the table like an adult and working together to help the taxpayers. So I appreciate you calling and sharing your story with me tonight. I really do. It's very, very helpful to me and thanks for being on the call tonight.