Leslie Smith is among millions of Americans scrambling to meet a fast-approaching deadline to lock in health insurance coverage for 2026.

Smith, a 64-year-old Arizona resident with diabetes, faces the daunting prospect of juggling more-expensive Affordable Care Act premiums with everyday living expenses. Smith delayed selecting her plan for 2026 coverage as Congress debated whether to extend maintain COVID-era subsidies that made Obamacare health insurance cheaper for 22 million Americans.

The Senate on Thursday rejected the Democrats proposal to maintain the subsidies. Because the Senate didn't extend the enhanced premium tax credits set to expire at the end of 2025, Smith and others face sharply higher costs for ACA insurance beginning Jan. 1, 2026.

And House Republicans released a legislative proposal aimed at making healthcare more affordable but without extending premiums under Obamacare. A House vote could come in the next week.

Obamacare enrollees must choose a plan by Monday, Dec. 15, to get coverage beginning Jan. 1, 2026.