Thousands of middle-class Californians who depend on the state-run health insurance marketplace face premiums that are thousands of dollars higher than last year because enhanced federal subsidies that began during the COVID-19 pandemic have expired.

Despite fears that more people would go without coverage with the end of the extra benefits, the number enrolling in Covered California has held steady so far, according to state data.

But that may change.

Jessica Altman, executive director of Covered California, said that she believes the number of people dropping their coverage could increase as they receive bills with their new higher premiums in the mail this month. She said better data on enrollment will be available in the spring.

Altman said that even though the extra benefits ended Dec. 31, 92% of enrollees continue to receive government subsidies to help pay for their health insurance. Nearly half qualify for health insurance that costs $10 or less per month. And 17% of Californians renewing their Covered California policies will pay nothing for premiums if they keep their current plan.

The deadline to sign up for 2026 benefits is Saturday.

Here’s help in sorting out what the expiration of the enhanced subsidies for insurance provided under the Affordable Care Act, often called Obamacare, means in the Golden State.

What expired?

In 2021, Congress voted to temporarily to boost the amount of subsidies Americans could receive for an ACA plan. The law also expanded the program to families who had more money. Before the vote, only Americans with incomes below 400% of the federal poverty level — currently $62,600 a year for a single person or $128,600 for a family of four — were eligible for ACA subsidies. The 2021 vote eliminated the income cap and limited the cost of premiums for those higher-earning families to no more than 8.5% of their income.

How could costs change this year for those enrolled in Covered California?

Anyone with income above 400% of the federal poverty level no longer receives subsidies. And many below that level won’t receive as much assistance as they had been receiving since 2021. At the same time, fast-rising health costs boosted the average Covered California premium this year by more than 10.3%, deepening the burden on families.

How much would the net monthly premium for a Los Angeles couple with two children and a household income of $90,000 rise?

The family’s net premium for the benchmark Silver plan would jump to $699 a month this year from $414 a month last year, according to Covered California. That’s an increase of 69%, costing the family an additional $3,420 this year.

Who else could face substantially higher health bills?

People who retired before the Medicare-qualifying age of 65, believing that the enhanced subsidies were permanent, will be especially hit hard. Those with incomes above 400% of the federal poverty level could now be facing thousands of dollars in additional health insurance costs.

How did enrollment in Covered California change after the enhanced subsidies expired on Dec. 31?

As of Jan. 17, 1,906,033 Californians had enrolled for 2026 insurance. That’s less than 1% lower than the 1,921,840 who had enrolled by this time last year.

Who depends on Covered California?

Enrollees are mostly those who don’t have access to an employer’s health insurance plan and don’t qualify for Medi-Cal, the government-paid insurance for lower-income people and those who are disabled.

An analysis by KFF, a nonprofit that provides health policy information, found that nearly half the adults enrolled in an ACA plan are small-business owners or their employees, or are self-employed. Occupations using the health insurance exchanges where they can buy an ACA plan include realtors, farmers, chiropractors and musicians, the analysis found.

What is the underlying problem?

Healthcare spending has been increasing faster than overall inflation for years. The nation now spends more than $15,000 per person on healthcare each year. Medical spending today represents about 18% of the U.S. economy, which means that almost one out of every five dollars spent in the U.S. goes toward healthcare. In 1960, health spending was just 5% of the economy.

What has California done to help people who are paying more?

The state government allocated $190 million this year to provide subsidies for those earning up to 165% of the federal poverty level. This money will help keep monthly premiums consistent with 2025 levels for those with an annual income of up to $23,475 for an individual or $48,225 for a family of four, according to Covered California.

Where can I sign up?

People can find out whether they qualify for financial help and see their coverage options at the website CoveredCA.com.

What if I decide to go without health insurance?

People without insurance could face medical bills of tens of thousands of dollars if they become sick or get injured. And under California state law, those without coverage face an annual penalty of at least $900 for each adult and $450 for each child.

The U.S. Department of Education has given San José State 10 days to comply with a list of demands after finding that the university violated Title IX concerning a transgender volleyball player in 2024.

A federal investigation was launched into San José State a year ago after controversy over a transgender player marred the 2024 volleyball season. Four Mountain West Conference teams — Boise State, Wyoming, Utah State and Nevada-Reno — each chose to forfeit or cancel two conference matches to San José State. Boise State also forfeited its conference tournament semifinal match to the Spartans.

The transgender player, Blaire Fleming, was on the San José State roster for three seasons after transferring from Coastal Carolina, although opponents protested the player’s participation only in 2024.

In a news release Wednesday, the Education Department warned that San José State risks “imminent enforcement action” if it doesn’t voluntarily resolve the violations by taking the following actions, not all of which pertain solely to sports:

1) Issue a public statement that SJSU will adopt biology-based definitions of the words “male” and “female” and acknowledge that the sex of a human — male or female — is unchangeable.

2) Specify that SJSU will follow Title IX by separating sports and intimate facilities based on biological sex.

3) State that SJSU will not delegate its obligation to comply with Title IX to any external association or entity and will not contract with any entity that discriminates on the basis of sex.

4) Restore to female athletes all individual athletic records and titles misappropriated by male athletes competing in women’s categories, and issue a personalized letter of apology on behalf of SJSU to each female athlete for allowing her participation in athletics to be marred by sex discrimination.

5) Send a personalized apology to every woman who played in SJSU’s women’s indoor volleyball from 2022 to 2024, beach volleyball in 2023, and to any woman on a team that forfeited rather than compete against SJSU while a male student was on the roster — expressing sincere regret for placing female athletes in that position.

“SJSU caused significant harm to female athletes by allowing a male to compete on the women’s volleyball team — creating unfairness in competition, compromising safety, and denying women equal opportunities in athletics, including scholarships and playing time,” Kimberly Richey, Education Department assistant secretary for civil rights, said.

“Even worse, when female athletes spoke out, SJSU retaliated — ignoring sex-discrimination claims while subjecting one female SJSU athlete to a Title IX complaint for allegedly ‘misgendering’ the male athlete competing on a women’s team. This is unacceptable.”

San José State responded with a statement acknowledging that the Education Department had informed the university of its investigation and findings.

“The University is in the process of reviewing the Department’s findings and proposed resolution agreement,” the statement said. “We remain committed to providing a safe, respectful, and inclusive educational environment for all students while complying with applicable laws and regulations.”

In a New York Times profile, Fleming said she learned about transgender identity when she was in eighth grade. “It was a lightbulb moment,” she said. “I felt this huge relief and a weight off my shoulders. It made so much sense.”

With the support of her mother and stepfather, Fleming worked with a therapist and a doctor and started to socially and medically transition, according to the Times. When she joined the high school girls’ volleyball team, her coaches and teammates knew she was transgender and accepted her.

Fleming’s first two years at San José State were uneventful, but in 2024 co-captain Brooke Slusser joined lawsuits against the NCAA, the Mountain West Conference and representatives of San José State after alleging she shared hotel rooms and locker rooms with Fleming without being told she is transgender.

The Education Department also determined that Fleming and a Colorado State player conspired to spike Slusser in the face, although a Mountain West investigation found “insufficient evidence to corroborate the allegations of misconduct.” Slusser was not spiked in the face during the match.

President Trump signed an executive order a year ago designed to ban transgender athletes from competing on girls’ and women’s sports teams. The order stated that educational institutions and athletic associations may not ignore “fundamental biological truths between the two sexes.” The NCAA responded by banning transgender athletes.

The order, titled “Keeping Men Out of Women’s Sports,” gives federal agencies, including the Justice and Education departments, wide latitude to ensure entities that receive federal funding abide by Title IX in alignment with the Trump administration’s view, which interprets a person’s sex as the gender they were assigned at birth.

San José State has been in the federal government’s crosshairs ever since. If the university does not comply voluntarily to the actions listed by the government, it could face a Justice Department lawsuit and risk losing federal funding.

“We will not relent until SJSU is held to account for these abuses and commits to upholding Title IX to protect future athletes from the same indignities,” Richey said.

San José State was found in violation of Title IX in an unrelated case in 2021 and paid $1.6 million to more than a dozen female athletes after the Department of Justice found that the university failed to properly handle the students’ allegations of sexual abuse by a former athletic trainer.

The federal investigation found that San José State did not take adequate action in response to the athletes’ reports and retaliated against two employees who raised repeated concerns about Scott Shaw, the former director of sports medicine. Shaw was sentenced to 24 months in prison for unlawfully touching female student-athletes under the guise of providing medical treatment.

The current findings against San José State came two weeks after federal investigators announced that the California Community College Athletic Assn. and four other state colleges and school districts are the targets of a probe over whether their transgender participation policies violate Title IX.

The investigation targets a California Community College Athletic Assn. rule that allows transgender and nonbinary students to participate on women’s sports teams if the students have completed “at least one calendar year of testosterone suppression.”

Also, the Education Department’s Office of Civil Rights has launched 18 Title IX investigations into school districts across the United States on the heels of the Supreme Court hearing oral arguments on efforts to protect women’s and girls’ sports.

On Wednesday, a new study published in JAMA by researchers at the University of Washington in Seattle projected that by 2035, nearly half of all American adults, about 126 million individuals, will be living with obesity. The study draws on data from more than 11 million participants via the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination and Behavioral Risk Factor Surveillance System, and from the independent Gallup Daily Survey.

The projections show a striking increase in the prevalence of obesity over the past few decades in the U.S. In 1990, only 19.3% of U.S. adults were obese, according to the study. That figure more than doubled to 42.5% by 2022, and is forecast to reach 46.9% by 2035.

The study highlights significant disparities across states, ages, and racial and ethnic groups. While every state is expected to see increases, the sharpest rises are projected for Midwestern and Southern states.

For example, nationwide, by 2035, the study projects that 60% (11.5 million adults) of Black women and 54% (14.5 million) of Latino women will suffer from obesity when compared with 47% (36.5 million) of white women. Similarly, 48% (13.2 million) of Latino men will suffer from the disease compared with 45% (34.4 million) of white men and 43% (7.61 million) of Black men.

The findings say California will see similar trends in gender and racial disparities. The study projects that by 2035, obesity rates among Latino and Black women in California will reach nearly 60%, compared with nearly 40% for their white counterparts. Additionally, Latino men in California could see rates over 50%, compared with nearly 40% for their white counterparts.

“These numbers are not surprising, given the systemic inequalities that exist,” in many California cities, said Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Hospital, pointing to economic instability, chronic stress and the car-dependency of Los Angeles and other California metro areas. “There are challenges for access to nutritious foods, depending on where you’re at in the city,” Velazquez said. ”There’s also disparities in the access to healthcare, especially to treatment for obesity.”

That’s recently become more of a challenge, since changes in Medi-Cal plans that went into effect at the beginning of this year mean obesity medication and treatment are no longer covered for hundreds of thousands of low-income Californians. “To take that away is devastating,” said Velazquez.

Despite these disparities, California is projected to fare better than most other states, with its rates of obesity growing more slowly than the national average.

“There are statewide and local policies that influence food, nutrition and social determinants of health for individuals,” said Velazquez.

Church pointed to measures such as SB 12 and SB 677, passed in the mid 2000s, which set strict nutritional standards for schools, existing menu labeling laws at both the state and federal levels requiring restaurants to provide nutritional facts on menu items, and cities like Berkeley and Oakland imposing local soda taxes as key local and statewide initiatives to keep obesity at bay.

To keep up this momentum, both doctors stressed that California must continue to strengthen school nutrition standards, expand transportation infrastructure that encourages walking instead of driving, maintain and expand economic disincentives to unhealthy foods, such as beverage taxes, and address food deserts by incentivizing new grocery stores and farmers’ markets in underserved neighborhoods.

Future efforts, Church says, should prioritize the Black and Latino populations identified by the study as most affected.