Millions of Americans are starting the year 2026 with higher health care premiums. COVID-era tax credits tied to the Affordable Care Act expired at midnight on Thursday, ending years of financial relief that kept premiums low for marketplace plans.

Premiums are expected to jump as much as 114%, according to health policy research organization KFF, formerly known as the Kaiser Family Foundation.

That spike is already hitting some small business owners in the Philadelphia suburbs.

In Hatboro, Montgomery County, wedding photographer Sarah Cunningham said her health insurance premium was $35.79 last month. In January, it jumped to $112.96 — more than triple the cost.

"I'm a business owner, so I don't have a boss to help me pay for my health insurance," Cunningham said. "I pay for it. So it's been hard."

Cunningham said she earns about $55,000 a year running her business, Sarah Anne Photography, but she's focusing on finances now more than ever. She said she's upset that Congress failed to pass legislation that would have extended subsidies for Affordable Care Act plans.

"I think a lot of the lawmakers, regardless whether you're red or blue, they really got to look at the American people," Cunningham said. "I don't think that they're looking at the American people in the middle class and lower class."

To offset the rising costs, Cunningham said she plans to rent out space in her studio to podcasters and other photographers. She's also considering taking on a second job.

"About two years ago, I took up Uber Eats because you can clock on when you're not busy and make a few bucks," Cunningham said. "I've been debating about going back to doing Uber Eats."

After experiencing a cervical cancer scare several years ago, Cunningham said health insurance is something she can't go without. With grocery prices and car insurance costs also rising, the single mother with a 14-year-old son said working more may be her only option.