To keep her aggressive form of breast cancer at bay, Rebecca Davis takes an expensive drug that is covered by just one insurance plan sold on Maryland’s state-run health exchange.

She bought the policy last year after her company went out of business and she lost her employer-sponsored coverage. The temporary health insurance offered during her unemployment had huge premiums, prompting her to turn to the exchange for a plan that now costs her “in the hundreds, rather than thousands” a month.

But Davis now faces higher insurance bills again.

That’s because the federal subsidies offsetting her premiums are expiring for 2026. And Congress seems no closer to resolving the issue, which has fueled the ongoing federal government shutdown.

“I’m a breast cancer survivor, and the drug I take to keep it from recurring cost $12,000 a month” on the retail market, she said during a Wednesday news event hosted by Rep. Jamie Raskin, a Montgomery County Democrat, to highlight the expected impact on so-called Obamacare open enrollment in Maryland, which begins Nov. 1.

“It’s a source of some anxiety,” Davis said after the event, adding she’s not yet explored what it would cost her for a new plan on the exchange.

Davis is among the 190,000 Marylanders who qualify for federal subsidies and could see premiums skyrocket on the exchanges created by the Affordable Care Act. Millions more around the country could face a similar fate.

Republican leaders have so far said they are willing to consider extending the subsidies, but only after the government reopens.

GOP officials argue the current level of subsidies enacted during the Biden administration were always intended as temporary, and are costly. The Congressional Budget Office estimates they would add $355 billion to the deficit over the next decade.

Raskin and other Democrats, however, said Wednesday that the subsidies allowed more people to afford coverage. State officials added that they are now worried because people will soon begin shopping for plans even as Congress remains undecided about the fate of the federal subsidies.

“It would be a scramble” to reset insurance rates and incorporate subsidies, and then get consumers to take another look at prices, said Michele Eberle, executive director of the Maryland Health Benefit Exchange.

Open enrollment lasts until Jan. 15.

The coverage is typically used by people who don’t get insurance through their jobs, which includes small-business owners, contractors and farmers — and now, former federal workers.

Almost 500,000 people in Maryland have signed up for such coverage, including individuals and families, plus many small-business employees.

In response to the expiring subsidies, Maryland officials say they plan to offer more limited subsidies, aiding lower-income residents in the state. That would leave thousands of people to not only face higher costs for plans as a result of rising costs generally for health care, but an additional increase, thanks to lack of federal subsidies.

Insurers who offer plans on the exchange have been approved by state officials to increase their rates by an average of 13.4%, which Eberle said was lowered through a state program. The increase is also lower than the national jump of 18%, according to the health care research group KFF.

The middle class, in particular, could feel the sting.

Officials offered several hypothetical examples, including a family of four with combined income of about $129,000 that had qualified for federal subsidies, but won’t qualify for upcoming state aid because they earn too much. The family would see its monthly health insurance bills rise 56% next year to $1,427 from $916 today.

For a family of four with a lower income of just over $80,000 that does qualify for the planned state subsidy, the bill would likely rise about 55% — around $419 a month next year, up from $271 this year. Without the state subsidy, the coverage would more than double to $568.

“Millions of people will not be able to afford to participate, and they will drop out,” Raskin said. “They will get sicker and end up in the emergency room and that will drive up everyone’s rates.”

Exchange officials had estimated some 70,000 people will drop their coverage because of the cost increase, a stark reversal for a state that has aggressively sought to enroll people, including through their tax and unemployment forms, for example.

State officials said keeping more people on the insurance rolls will increase their access to primary health care, which in turn can keep them healthy. With more people insured, experts say, the broader health care system can also benefit by reducing the chances those people will have to use more expensive services at hospitals.

About 6% Marylanders are uninsured, down from 12% before the federal health care law went into effect in 2014.

The exchange may gain some enrollees from the federal workforce, which has lost tens of thousands of jobs under the Trump administration. State officials said at least 2,000 former federal workers in Maryland recently filed for unemployment insurance.

Some former and furloughed workers said at a recent resources event in Howard County that they didn’t think that much about exchange coverage previously.

Now they see it as a crucial safety net, and were relieved to hear it could cost less than COBRA-style coverage. But costs remain a concern for many, including Rosalind Carrington, a single mother from Howard County.

“What would be our choice?” she said. “We don’t want to go without health insurance.”