What Happened |
Enhanced tax credits that lowered Affordable Care Act marketplace premiums for the past four years expired at the start of 2026. First introduced in 2021 as a temporary pandemic-era measure, the subsidies were later extended through the end of 2025. With no last-minute deal in Congress, millions of people who buy coverage on their own are now locked into higher monthly premiums for 2026. |
The change affects a specific slice of the country. It impacts people who do not get insurance through an employer and do not qualify for Medicare or Medicaid. That includes many self-employed workers, small business owners, farmers and ranchers, and early retirees who are not yet eligible for Medicare. |
Under the expanded credits, some lower-income enrollees paid little to nothing in premiums. Higher earners were capped at paying no more than 8.5% of their income for benchmark coverage. Eligibility was also widened to include many middle-income households that previously received little or no help. |
With those protections gone, premium increases are arriving fast. An analysis from KFF estimates that, in 2026, more than 20 million subsidized marketplace enrollees will see their average monthly premium costs rise by about 114%. That equals roughly $400 per month compared to 2023 levels. |
Congress could reconsider. A House vote in January may reopen the issue. Passing a fix remains uncertain and would also require Senate approval. Meanwhile, open enrollment is available in most states until January 15, so many must decide now under higher prices. |
Why It Matters |
The ACA marketplaces depend on a balanced risk pool. If younger, healthier people decide coverage is no longer worth the cost, they are more likely to drop out. That leaves a pool that is, on average, older and sicker. This dynamic tends to push premiums even higher over time. |
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Analysts have been warning about this for months. A September prediction from the Urban Institute and the Commonwealth Fund estimated that if premiums rise, about 4.8 million Americans could lose health insurance coverage in 2026. Even if the actual number is lower, the pattern remains. Higher premiums often lead to lower enrollment. |
Healthcare costs are a top voter concern. There is also a fiscal side for taxpayers. Subsidies cost money, but so does uncompensated care when uninsured people delay treatment and go to the ER. Hospitals and states often bear that cost. It can then raise premiums, budgets, and other charges. |
How It Affects Readers |
A premium that doubles or even triples will come with immediate trade-offs. These include keeping insurance rather than paying rent, staying on a plan rather than dropping coverage for one family member, or moving to a higher-deductible plan that looks cheaper up front but exposes households to high out-of-pocket costs later. |
The impact will vary by age, income, and geography. A healthy individual may gamble and go uninsured. A parent with a child who needs regular care may cut elsewhere to keep coverage. People with chronic conditions may pay higher premiums because they do not have a real alternative. In every case, the stress falls on families making rational choices under tighter constraints. |
Small business owners and self-employed workers are likely to be hit hardest, as employer plans spread risk across large groups. Marketplace buyers do not have that cushion. Many run their finances on thin margins. Higher premiums can function like a new fixed cost. That cost arrives regardless of whether business is up or down that month. |
The most practical step for readers is to use caution when shopping during open enrollment. Plan networks, deductibles, and drug formularies matter more when prices rise. While many will find cheaper options, many will still face meaningful increases because the subsidy structure has changed. |
If Congress does not restore the credits soon, millions will pay more for the same insurance. Many will drop coverage entirely. |
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