Richmond’s creative economy has always been powered by risk-takers like musicians, painters, actors, writers, photographers, makers, and the small business owners who keep the city’s galleries, venues, and shops alive. Many piece together a living from passion projects, gig work, and side hustles, often without the safety net of employer-provided insurance. The Affordable Care Act (ACA) has been the bridge between living without insurance and being able to afford a doctor’s visit.
That bridge is about to get narrower, and more expensive.
What’s Happening
As reported by the Richmond Times Dispatch, the State Corporation Commission’s Bureau of Insurance announced that premiums for individual ACA plans in Virginia are set to jump by an average of 20.5% in 2026 if Congress lets the Enhanced Premium Tax Credits (EPTCs) expire at the end of 2025. That’s roughly $96 more per month for those buying coverage on the marketplace, raising the average premium from $498.89 to $594.98.
Without Virginia’s Commonwealth Health Reinsurance Program (see below), a state initiative that offsets insurers’ highest-cost medical claims to keep premiums stable — that same monthly bill would soar to $711.70
The main reason: the expiration of COVID-era EPTCs, which have been saving Virginians about $87.80 per month since they were enacted in 2021. The Republican-controlled Congress declined to renew them in President Donald Trump’s “One Big Beautiful” tax and budget bill, and so far there’s no movement to restore them.
Who’s Affected
- Nearly 415,000 Virginians currently buy their coverage on the ACA marketplace.
- The SCC estimates more than a third of them could drop their plans entirely once the credits disappear.
- Those most vulnerable are freelancers, small business owners, artists, part-time workers, and others without employer-based insurance, a large share of Richmond’s arts and gig economy.
Why Premiums Will Rise Even More Without Subsidies
Health insurers warn that without the tax credits, many healthier people will leave the marketplace to save money. That leaves a smaller, less healthy pool of insured customers, which drives up per-person claim costs, a cycle that leads to even higher rates.
Other cost pressures include:
- Increased illness severity among those seeking treatment.
- Higher hospital and pharmacy costs.
- Greater utilization of health services compared to pre-pandemic levels.
What the SCC Says
The SCC’s August 7, 2025 release breaks down how the marketplace is shaping up for 2026:
- 10 insurers participate in Virginia’s ACA marketplace.
- Proposed average increases for individual market plans range from 3% to 40.2%.
- Largest market share: HealthKeepers, which is seeking a 20.4% increase.
- Other proposed hikes in the Richmond area:
- Sentara: 20.6%
- Cigna: 22.3%
- Anthem: 23.1%
- Optimum: 40.2%
- Kaiser: 11.6%
- Oscar Insurance: 3%
The SCC reviews all rate filings to ensure they’re “reasonable”, balancing consumer protection with insurer solvency so companies can pay claims. But if the subsidies vanish, the approved rates will still reflect the absence of that financial assistance.
What About Small Group Plans?
Small group coverage, plans offered by small businesses, didn’t benefit from the EPTCs. Even so, insurers are requesting an average 11.2% increase for these policies in 2026, citing higher claims costs. That will hit independent shops, restaurants, and creative businesses that employ small teams.
Reinsurance Offers Temporary Relief
Virginia’s Commonwealth Health Reinsurance Program currently lowers individual premiums by about 15% from what they’d otherwise be. It works by reimbursing insurers for some of the costliest claims, and is funded in part by federal savings from reduced tax credit payments. But the program is only authorized through 2027, meaning that even this partial buffer isn’t permanent.
Why It Matters for Richmond’s Creative Economy
The city’s galleries, music venues, festivals, and arts nonprofits depend heavily on independent workers who already operate on thin margins. A $100-per-month increase in health insurance could be the breaking point for many.
“When you’re a working artist, you don’t have the luxury of absorbing a $100-a-month increase,” said one local gallery owner. “That’s rent money. That’s food money. That’s the difference between staying in this city and moving somewhere cheaper.”
The loss of coverage would ripple outward:
- Hospitals: Michael Elliott, COO of VCU Health System, warns that uninsured patients often delay care until their conditions are severe, resulting in more expensive treatment and higher uncompensated care. Those costs are passed on to the insured through higher premiums.
- Events & Businesses: If creatives leave Richmond or cut back on work to save money, local festivals, restaurants, and retail tied to the arts economy lose both talent and customers.
- Community Health: Losing insurance means skipping preventive care, which leads to worse long-term health outcomes and higher public health costs.
The Bottom Line
If Congress doesn’t act to extend the Enhanced Premium Tax Credits, 2026 could bring:
- Fewer insured Virginians
- Higher costs for those who remain
- Greater financial strain on hospitals
- A shrinking and stressed creative workforce in Richmond
This isn’t just a health care story, it’s an economic one. And in a city where art, music, and culture are part of the civic identity, the loss of affordable coverage threatens far more than individual bank accounts.
Photo by Marc Newberry
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