Artist Lise Goddard inside her studio on Thursday. Goddard is a former school administrator who started a business as an artist a few years ago. She was able to do so because of low Affordable Care Act premiums, which will expire this year unless extended by Congress. Shawn Patrick Ouellette/Portland Press Herald

Lise Goddard recently launched her new career as a fabric and stained glass artist — a passion she says she could not have pursued without being able to purchase health insurance on the Affordable Care Act marketplace.

Goddard, 54, of Sebago, said she’s watching to see whether Congress extends tax credits that were first approved in 2021 and help reduce the cost of insurance premiums, often by hundreds of dollars each month.

The enhanced tax credits have reduced premiums for 85% of people on the marketplace, including nearly 55,000 Mainers.

But the tax credits are set to expire at the end of the year unless Congress passes an extension. While policyholders and health care advocates are stepping up pressure to maintain the subsidies, they face an uphill battle with Republicans — who have generally been opposed to the ACA — in control of Congress and the White House.

Because of the way the tax credits are structured, those most affected if the enhanced credits expire would be lower-income enrollees earning between 135% and 200% of the federal poverty level, or $31,300 for a single person, and those who earn more than 400% of the federal poverty level — $62,600 for a single person, or $128,600 for a family of four. The enhanced credits shield people from paying more than 8.5% of their annual income on insurance premiums.

The enhanced subsidies led to significant increases in the number of Americans insured through the marketplace — more than 24 million people are now enrolled.

The Congressional Budget Office estimates that permanently extending the subsidies would cost $335 billion over the next 10 years. While some Republicans have balked at the cost, advocates argue that allowing the subsidies to expire would effectively raise premiums for millions of Americans several months before the 2026 midterm elections.

Goddard said she has “extraordinarily good insurance” and pays $130 in premiums per month, which covers her and a 22-year-old son. Her husband, Jeff, is 70 and qualifies for Medicare insurance.

If she had to pay hundreds more per month, “that would do me in. I wouldn’t be able to continue what I’m doing as an artist.”

In Maine, the average premium would increase by $2,100 annually, or $175 monthly. But the premium increases would vary widely, depending on a number of factors, such as age, income and geography, as enrollees in rural areas would see higher increases.

Some of the monthly premium increases would jump $600 to $700 or more, according to Maine state officials. All together, $26 million in monthly premium savings would be lost in Maine alone if the credits expired, according to state statistics.

Artist Lise Goddard outside her studio on Thursday. Shawn Patrick Ouellette/Portland Press Herald

Goddard said part of the reason she was able to leave her job as a school administrator in 2023 and try to make a living as an artist was the reasonable prices for insurance through the ACA.

“The peace of mind, knowing I have this insurance, is important, and it allows me to live the life I want to live,” Goddard said.

Ann Woloson, executive director of Consumers for Affordable Health Care, a nonprofit advocacy group, said ACA insurance is especially crucial in Maine because of the large number of people who are self-employed, or own small businesses that don’t have employer-based insurance.

“If you look at our industries — self-employed people, like the fishing industry and lobstering — some people are going to roll the dice and go uninsured if these tax credits go away,” Woloson said.

Woloson said that would leave those who remain in the marketplace in an insurance pool of older, sicker workers, driving costs up. And people who are uninsured tend to delay their care, also driving up costs with more reliance on emergency department care. System costs will also increase if people use less preventive care and let their health conditions deteriorate before seeking health care, which is also more costly.

“What that means is everyone would pay more for their health insurance,” Woloson said.

Alicia Romac, 57, a real property appraiser who lives in Bath, said she doesn’t know what she would do if she couldn’t get affordable health insurance through the ACA marketplace.

“If the ACA didn’t exist, it would stifle entrepreneurialism in the country,” Romac said. “To best execute your business ideas, you need to be healthy and have health insurance.”

Romac said she would like members of Congress — who enjoy a generous public health care plan — to look out for the public as much as they look to preserve their own benefits.

“They’re willing to cut public subsidies for the ACA, while at the same time keeping their own public subsidy,” Romac said.

Aaron Child, of Damariscotta, said he has an ACA plan, and as a self-employed arborist who cuts down trees, going uninsured would be “foolish.” But if he had to pay hundreds more per month, it would be a hardship.

“Something would have to give,” Child said.

Hilary Schneider, Maine’s director of the Office of the Health Insurance Marketplace, said many Maine people will “not be able to shoulder” these premium increases, posing a threat to their health, financial well-being and the overall economy. The agency Schneider runs operates the coverme.gov website, which is where consumers can compare plans and purchase ACA insurance.

“These are our friends, neighbors, home care workers, hairdressers, technicians, people who left corporate jobs to start their own businesses,” Schneider said. “These are the bedrocks of our communities.”

According to KFF, a national health policy think tank, a 60-year-old couple living in northern Maine with an annual income of $82,000 and coverage under a so-called silver plan would see premiums increase from $581 per month to $2,420 per month if the enhanced credits expired.

The Mills administration is publicly calling on Congress to maintain the enhanced subsidies, and last week, it issued statements and fact sheets to call attention to the potential expiration. Congress will need to decide by the end of the year whether to maintain the credits at the same time it is negotiating many other major pieces of the federal budget, including possible cutbacks to Medicaid that also could leave many Mainers without access to health insurance.

Sen. Angus King, I-Maine, introduced legislation in January that would preserve the credits. But whether there’s enough Republican support to save the subsidies is unclear. Sen. Lisa Murkowski, R-Alaska, is so far the only Senate Republican to voice support for keeping the credits.

Sen. Susan Collins, R-Maine, is against Medicaid cutbacks, but has so far been noncommittal about the enhanced premium tax credits.

“Senator Collins voted to protect the Affordable Care Act and she supports making health care accessible for Maine families,” said Blake Kernen, a Collins spokesperson. “Senator Collins is considering several tax proposals, and she has questions about how this would be funded while also ensuring Medicaid is protected from cuts.”

Collins and Murkowski were two of three Republican senators — the other was the late John McCain of Arizona — who voted against their party in 2017 to protect the ACA from being dismantled. But Republicans hold a greater majority in the Senate than they did in 2017 — a four-seat majority now compared to a two-seat majority in 2017 — and also control a majority of seats in the House of Representatives and the White House.

The Trump administration has not weighed in specifically on the enhanced tax credits, although President Trump has generally been hostile to the ACA.

James Myall, policy analyst for the Maine Center for Economic Policy, said the “ripple effects” of losing the enhanced subsidies will reach far, especially in rural Maine, where there are not as many jobs with employer-based insurance.

“This would shrink the state economy,” Myall said, also pointing out that it would make the workforce shortage worse. “The No. 1 reason workers who are not of retirement age are not working is because their health is bad.”

Goddard, the Sebago artist, said not having to worry about insurance made taking the risk of switching careers less scary.

“When I looked into it, I thought, ‘this is doable,'” Goddard said. “The freedom that it has offered me was a huge factor in my decision.”