Californians renewing their public health plans or who plan to sign up for the first time will be in for sticker shock when open enrollment begins on Saturday. Monthly premiums for federally subsidized plans available on the Covered California exchange — often referred to as Obamacare — will soar by 97% on average for 2026.

The skyrocketing premiums come as a result of a conflict at the center of the current federal government shutdown, which began on Oct. 1: a budgetary impasse between the Republican majority and Democrats over whether to preserve enhanced, Biden-era tax credits that expanded healthcare eligibility to millions more Americans and kept monthly insurance costs affordable for existing policyholders. About 1.7 million of the 1.9 million Californians currently on a Covered California plan benefit from the tax credits.

Open enrollment for the coming year runs from Nov. 1 until Jan. 31. It’s traditionally the period when members compare options and make changes to existing plans and when new members opt in.

Only this time, the government shutdown has stirred uncertainty about the fate of the subsidies, first introduced during the COVID-19 pandemic and which have been keeping policy costs low, but will expire at the end of the year if lawmakers in Washington don’t act to extend them.

Californians window shopping on the exchange’s consumer homepage will have to make some tough decisions, said Covered California Executive Director Jessica Altman. The loss of the tax credits to subsidize premiums only adds to what can already be a complicated, time-consuming and frustrating process.

Even if the subsidies remained intact, premiums for plans offered by Covered California were set to rise by roughly 10% for 2026, due to spikes in drug prices and other medical services, Altman said.

Without the subsidies, Covered California said its members who receive financial assistance will see their monthly premiums jump by an additional $125 a month, on average, for 2026.

The organization projects that the cost increases will lead many Californians to simply go without coverage.

“Californians are going to be facing a double whammy: premiums going up and tax credits going away,” Altman said. “We estimate that as many as 400,000 of our current enrollees will disenroll and effectively be priced out of the health insurance that they have today. That is a devastating outcome.”

Indeed, the premium spike threatens to lock out the very Americans that the 2010 Affordable Care Act — President Obama’s signature domestic policy win — was intended to help, said Altman. That includes people who earn too much to qualify for Medicaid but who either make too little to afford a private plan or don’t work for an employer that pays a portion of the premiums.

That’s a broad swath of Californians — including many bartenders and hairdressers, small business owners and their employees, farmers and farm workers, freelancers, ride-share drivers, and those working multiple part-time gigs to make ends meet. The policy change will also affect Californians who use the healthcare system more frequently because they have ongoing conditions that are costly to treat.

By raising the tax-credit eligibility threshold to include Americans earning more than 400% of the federal poverty level, the Biden-era subsidies at the heart of the budget stalemate have brought an estimated 160,000 additional middle-income Californians into the system, Covered California said. The enhanced subsidies save members about $2.5 billion a year overall in out-of-pocket premium expenses, according to the exchange.

California lawmakers have tried to provide some relief from rising Covered California premiums by recently allocating an additional $190 million in state-level tax credits in next year’s budget for individuals who earn up to 150% of the federal poverty level. That would keep monthly premiums consistent with 2025 levels for a person making up to $23,475 a year, or a family of four bringing in $48,225 a year, and provide partial relief for individuals and households making slightly more.

Altman said the state tax credits will help. But it may not be enough. Forecasts from the Urban Institute, a nonprofit research group and think tank, also show a significant drop-off of roughly 400,000 enrolled members in Covered California.

The national outlook is even worse. The Congressional Budget Office warned Congress nearly a year ago that if the enhanced premium subsidies were allowed to expire, the ranks of the uninsured would swell by 2.2 million nationwide in 2026 alone — and by an average of 3.8 million Americans each year from 2026 to 2034.

Organizations that provide affordable Obamacare plans are preparing for Californians to get squeezed out of the system if the expanded subsidies disappear.

L.A. Care, the county’s largest publicly operated health plan, offers Covered California policies for 230,000 mostly lower-income people. About 90% of the Covered California consumers they work with receive subsidies to offset their out-of-pocket healthcare insurance costs, said Martha Santana-Chin, L.A. Care’s CEO. “Unless something drastic happens … a lot of those people are going to fall off of their coverage,” Santana-Chin said.

That outcome would ripple far and wide, she said — thanks to two factors: human behavior and basic economics.

If more and more people choose to go uninsured, more and more people will resort to visiting hospital emergency rooms for non-emergency care, disrupting and overwhelming the healthcare system.

Healthcare providers will be forced to address the cost of treating rising numbers of uninsured people by raising the prices they bill to insurers for patients who have private plans. That means Californians who are not Covered California members and don’t receive other federal healthcare aid will eventually see their premiums spike too, as private insurers pass any added costs down to their customers.

But right now, with the subsidies set to end soon and recent changes to Medicaid eligibility requirements threatening to knock some of the lowest-income Californians off of that system, both Altman and Santana-Chin said their main concern is for those who don’t have alternatives.

In particular, they are concerned about people of color, who are disproportionately represented among low-income Californians, according to the Public Policy Institute of California. Any hike in out-of-pocket insurance costs next year could blow the budget of a family barely getting by.

“$100, $150, $200 — that’s meaningful to people living on fixed incomes,” Altman said. “Where is that money coming from when you’re living paycheck to paycheck?”

A controversial plan to kill one owl species to save another cleared a major hurdle.

The full Senate on Wednesday struck down a GOP effort to prevent the cull of up to 450,000 barred owls in the Pacific Northwest over three decades, ending a saga that created strange political bedfellows.

It’s a major win for environmentalists and federal wildlife officials who want to protect northern spotted owls that have been crowded out by their larger, more aggressive cousins. In recent weeks they got an unlikely ally in loggers who said scuttling the U.S. Fish and Wildlife Service plan could hinder timber sales.

But it’s a blow to an equally unusual alliance that includes right-wing politicians and animal rights advocates who argue the cull is too expensive and inhumane. The Trump administration leaned on Republican lawmakers to get out of the way, scrambling partisan lines.

Sen. John Kennedy, a conservative from Louisiana, sought to nix the owl-killing plan via the Congressional Review Act, which can be used to overturn recent rules by federal agencies.

Kennedy said Interior Secretary Doug Burgum, whose portfolio includes timber production, recently called him and told him to abandon the resolution. This month logging advocates said that stopping the cull would jeopardize timber production goals set by the Trump administration.

But Kennedy was not persuaded.

“The secretary needed to call somebody who cared what he thought, because I think he’s wrong,” Kennedy said on the Senate floor. “I think he and the other members of the administrative state at the Department of the Interior decided to play God.”

Flanked by pictures of owls and bumbling cartoon hunter Elmer Fudd, Kennedy praised barred owls for their “soulful eyes” and “incredibly soft” feathers. But he acknowledged they’re better hunters than spotted owls. Barred owls, which moved over from eastern North America, are outcompeting spotted owls for food and shelter in their native territory.

Ultimately the resolution failed 72 to 25, with three lawmakers not voting. Nearly all those who voted in favor of the resolution were Republican, but even more Republicans voted against it. The Fish and Wildlife Service approved the barred owl cull last year under the Biden Administration.

“I feel a lot of relief because this was one of the most major threats to the long-term, continued existence of the northern spotted owl in many years,” said Tom Wheeler, executive director of the Environmental Protection Information Center. “We’ve passed this hurdle, which isn’t to say there aren’t other hurdles or road bumps up ahead, but this feels good.”

Wheeler described the failed effort as a “nuclear threat” — if the resolution had passed, the Fish and Wildlife Service would have been blocked from pursuing any similar rule, unless explicitly authorized by Congress.

Now Wheeler said he and his allies will continue to push for the owl cull to be carried out, and for federal funding to support it.

Animal welfare advocates like Wayne Pacelle, president of Animal Wellness Action and Center for a Humane Economy, are dismayed.

“What this means is that not only are barred owls at extreme risk of large-scale shooting, but spotted owls and old-growth forests are at risk from chainsaws,” Pacelle said of the failed resolution.

Pacelle’s camp vowed to continue the fight. A lawsuit challenging the hunt they filed against the federal government last fall is moving forward. And they’ll try to ensure money doesn’t flow to the program.

In May, federal officials canceled three related grants in California totaling more than $1.1 million, including one study that would have included lethally removing barred owls from more than 192,000 acres in Mendocino and Sonoma counties.

However, there are other projects to kill barred owls in the Golden State, according to Peter Tira, a spokesperson for the California Department of Fish and Wildlife.

One $4.3-million grant issued by the state agency will support barred owl removal in the northwestern part of the state, along with other research. Another grant issued by NASA to a university involves killing barred owls in California as well as creating a tool to prioritize areas where the raptors need to be managed.

It’s not clear how or if the government shutdown, now stretching into its 31st day, is affecting the projects, Tira said in an email.

Over the last decade, clinics have popped up across Southern California and beyond advertising something called magnetic e-resonance therapy, or MERT, as a therapy for autism.

Developed by the Newport Beach-based company Wave Neuroscience, MERT is based on transcranial magnetic stimulation, a type of brain stimulation that’s approved by the Food and Drug Administration to treat depression, obsessive-compulsive disorder, migraines and smoking addiction.

Clinics licensing MERT have claimed that their trademarked version of the treatment can also produce “miraculous results” in kids with autism, improving their sleep, emotional regulation and communication abilities. A six-week course of MERT sessions typically costs $10,000 or more.

The FDA hasn’t approved MERT for this use. However, prescribing drugs or devices for conditions they aren’t approved for, which is known as off-label prescribing, is a legal and common practice in medicine.

But when such treatments are offered to vulnerable people, a group of researchers argue in a new peer-reviewed editorial in the medical journal Transcranial Magnetic Stimulation, they should be evidence-based, clearly explained to patients and priced in a way that reflects the likelihood that they will work as advertised.

Most clinics advertising off-label TMS as a therapy for autism don’t meet those standards, the researchers say.

Autism is “the biggest off-label business … [and] the one that is the greatest concern,” said Dr. Andrew Leuchter, director of UCLA’s TMS Clinical and Research Service.

Leuchter is one of three researchers with TMS expertise who recently called for the establishment of ethical guidelines around off-label TMS marketing in the field’s primary journal.

Written with Lindsay Oberman, director of the Neurostimulation Research Program at the National Institute of Mental Health, and Dr. Holly Lisanby, founder of the NIMH Noninvasive Neuromodulation Unit and dean of Arizona State University’s School of Medicine and Advanced Medical Engineering, the editorial singles out MERT as an “example of off-label TMS where there is negligible evidence of efficacy.”

“There is extremely limited scientific evidence at present that any form of TMS has efficacy and safety in improving the core symptoms of language, social skills, or behavioral disturbances associated with [Autism Spectrum Disorder],” the editorial states. “Websites and other promotional materials that fail to acknowledge this limited evidence-base can create a risk of bias and potential for false expectations.”

Dr. Erik Won, Wave’s president and chief medical officer, did not respond to requests for comment.

A Times investigation last year found there are no large scientific studies demonstrating that MERT is significantly better than a placebo at improving speech and communication challenges associated with autism. Wave has not conducted any clinical trials on MERT and autism.

Won said last year that Wave is working to obtain funding “for further studies and ultimately an FDA indication.”

Websites for clinics offering MERT often feature written testimonials from parents describing what they saw as positive changes in their children’s moods or spoken-language abilities after treatment sessions.

Without data, however, there is no way to know whether a patient’s anecdotal experience is typical or an outlier, according to Zoe Gross of the Autistic Self Advocacy Network, a nonprofit group run by and for autistic adults.

“Be wary of therapies that are sold to you with testimonials. If you go to a clinic website and they have dozens of quotes from parents saying, ‘This changed my child’s life in XYZ ways,’ that isn’t the same as evidence,” Gross told The Times last year.

A therapy could have only a 1% success rate, she said, and still yield dozens of positive testimonials once thousands of people have tried it.

For families unsure of whether a particular commercial therapy might be valuable for their child, “ask the advice of a clinician or an autism scientist who is not connected to the facility providing a service, just to get a frank appraisal of whether it’s likely to be helpful or likely to be worth the money,” said James McPartland, director of the Yale Center for Brain and Mind Health, who is currently studying the relationship between TMS and social perception in autistic adults. “Before you want to ask someone to spend resources on it, you want to have a certain degree of confidence [that] it’s going to be useful.”