The expiration of enhanced tax credits for Affordable Care Act (ACA) marketplace plans at the close of 2025 is projected to result in significantly increased health insurance costs for millions of Americans beginning in the new year. Congressional discussions regarding the potential reinstatement of these subsidies are ongoing, but no legislation to extend them materialized before key deadlines. This development is anticipated to lead to higher monthly premiums for many individuals and an estimated 4.8 million people losing health insurance coverage.
Background on Subsidies and Congressional Action
Enhanced tax credits have provided financial assistance to ACA plan enrollees with plan costs since 2021. The conclusion of a recent government shutdown occurred without a resolution on these subsidies. Senate Republicans had committed to a vote on the enhanced subsidies before the end of the year. Open enrollment for 2026 ACA plans is currently underway, and consumers are facing increased prices and uncertainty regarding future financial relief.
Projected Financial Impacts
Insurers have adjusted plan prices upwards, anticipating that the absence of tax credits in 2026 could lead to a shift in the insured population, potentially resulting in a pool of sicker, costlier customers. Premiums on the ACA marketplaces are projected to increase by an average of 26% next year, according to KFF, marking the largest rate increase since 2018. The deadline for enrolling in a plan that begins January 1 is December 15. If Congress does not act before this deadline, some individuals may face substantially higher premiums or forgo insurance entirely.
Individual and Family Case Studies
Numerous individuals and families nationwide are reporting significant projected increases in their health insurance premiums for 2026 without the enhanced subsidies:
- Amy Jackson (56, Butler, Mo.): A medical billing worker, projects her monthly premium to increase from $275 to $1,250. Diagnosed with breast cancer, she requires ongoing coverage.
- Robert Bixon (61, Boynton Beach, Fla.): A retiree, anticipates monthly premiums of $4,500 to cover himself, his wife, and one son, totaling $54,000 annually. Potential out-of-pocket maximums could add up to $15,000.
- Ezra McKay (26, Memphis, Tenn.): A part-time bookseller with bipolar disorder, currently pays $15 monthly. His premium is projected to increase to $550 monthly, representing nearly half of his income. He is considering relocation to states with more secure coverage options.
- Catriona Johnson (44, Chapel Hill, N.C.): A social worker with a congenital abnormality, currently pays $442 monthly. Her premium is projected to increase to $666 next year, with her deductible rising by $1,000. She relies on ongoing medical care.
- Chris O'Donnell (58, Richmond, Va.): A freelance business owner, currently pays $837 monthly for a plan covering himself and his wife. The 2026 cost is projected to be $2,155 monthly, an increase of $1,300. His wife has diabetes and is a cancer survivor.
- Celeste Jameson (41, North Port, Fla.): A paralegal, projects her monthly premiums to increase from $266 to $593. She received an endometriosis diagnosis after gaining reliable ACA coverage in 2014.
- Kelly Badeau (Tucson, Ariz.): Faces an increase from $94 per month to an estimated $900 for her silver ACA plan. Her husband may require prostate cancer treatment, and she uses hormone therapy and blood pressure medication.
- Genna Boatright (40, Siren, Wis.): With rheumatoid arthritis, currently pays $12 monthly. Her premium is projected to be $700 without the tax credit. She was denied Medicaid coverage.
- Kristine Weidner (62, Branford, Conn.): A self-employed psychotherapist, anticipates her high-deductible ACA plan increasing from $589 monthly to $1,691 monthly for a comparable plan. She is considering returning to employer-based insurance.
- Robert and Emily Sory (Nashville, Tenn.): Operators of an animal sanctuary, face a lack of health insurance for 2026. Robert's previous zero-dollar monthly premium ACA plan is now quoted at a minimum of $70 per month for a basic Bronze plan, which he has deemed unaffordable. Emily lost her job-based insurance in November. They are considering strategies such as negotiating direct payment rates for psychiatric visits and using emergency room visits for acute issues, expecting billing and repayment plans.
- B.'s Family (Providence, R.I.): After job loss, their "gold" plan previously cost approximately $2,000 per month. Without enhanced subsidies, the projected monthly cost for 2026 will increase to nearly $3,000. They plan for their children to receive free coverage through Medicaid and for B. and her husband to purchase an ACA marketplace plan at an estimated $1,200 per month, utilizing retirement savings.
- Cynthia Freeman (61) and Brad Lawrence (52) (Brooklyn, N.Y.): Freelancers relying on an ACA plan. Lawrence's kidney disease requires ongoing medication costing an estimated $760 per month without insurance. Their current "silver" plan is projected to increase by nearly 75% to $801 per month. This price assumes a combined income of approximately $60,000 for 2026. If their household income exceeds $100,000, they would no longer qualify for subsidies, potentially pushing premiums above $2,000 per month. Freeman is considering full-time employment to access health benefits.
- Nicole Benisch (45, Providence, R.I.): A holistic wellness business owner, currently pays $108 per month for a zero-deductible "silver" plan. For 2026, this cost is projected to more than double to $220. She is reconsidering marriage, as a combined income with her fiancé exceeding 400% of the federal poverty level would make her ineligible for financial assistance, increasing her premium to over $700 per month.
- Adrienne Martin (47, Texas): Her family's monthly healthcare premium is projected to increase from $630 to $2,400 in 2026. Her husband requires an intravenous medication for a blood-clotting condition, costing approximately $70,000 per month without insurance. The family acquired a supply of the medication for the initial months of the year.
- Mathew (40, Michigan): With an autoimmune condition requiring medication transfusions, his ACA plan premium rose from $181 to over $427 per month after the subsidies expired, which he stated he could not manage. To secure health coverage, he married his best friend, Christina, who is also his roommate, to access her employer-sponsored health plan. Their new plan, which began in January, costs $121 per month. Erin Fuse Brown, a health law professor at Brown University School of Public Health, noted that marrying for benefits, while not illegal, was more prevalent before the ACA expanded affordable coverage options, and the expiration of enhanced tax credits indicates a trend back towards a pre-ACA environment.
Impact on Healthcare Providers and Uninsured Populations
Hospitals and clinics anticipate an increase in patients without insurance. Federally Qualified Health Centers (FQHCs), which receive federal funding, offer services on a sliding scale based on a patient's ability to pay. Some FQHCs also operate on-site pharmacies, which may partner with organizations like the Dispensary of Hope, a nonprofit that distributes donated medications to uninsured individuals with annual incomes below 300% of the federal poverty limit. These medications primarily cover chronic conditions such as hypertension, diabetes, and mental health issues.
The financial strain on hospitals may intensify, particularly in the ten states that have not expanded Medicaid under the ACA, such as Tennessee. Non-expansion of Medicaid, an optional ACA provision predominantly funded by federal dollars, contributes to a "Medicaid gap" where working, low-income adults may lack affordable insurance options. Projections from the Urban Institute indicate that uninsured rates could rise by as much as 65% in Mississippi and 50% in South Carolina due to this gap.