Millions of Americans are facing significant increases in health insurance premiums and challenges in maintaining coverage, following the expiration of enhanced tax credits for Affordable Care Act (ACA) plans at the close of 2025. This development has prompted individuals to make varied and often difficult financial and healthcare decisions.
Overview of Subsidy Expiration
Enhanced tax credits, which had assisted ACA plan enrollees with plan costs since 2021, concluded at the end of 2025. Congressional inaction on extending these subsidies during the recent government shutdown and prior to key deadlines resulted in their expiration. Senate Republicans had committed to a vote on these subsidies before the end of the year, but no legislation was enacted.
Open enrollment for 2026 plans began with consumers facing higher prices and significant uncertainty.
Impact on Premiums and Enrollment
The expiration of these subsidies is projected to significantly increase health insurance costs for many enrollees.
- ACA marketplace premiums are projected to increase by an average of 26% for 2026, according to KFF, marking the largest rate increase since 2018.
- KFF data also indicates that ACA plan premiums doubled on average following the subsidy expiration.
- Approximately 24 million people rely on ACA marketplaces for health coverage.
- The expiration of enhanced subsidies is projected to result in approximately 4.8 million individuals losing health insurance coverage.
- Federal data from mid-January 2026 showed a reduction of over one million people signed up for ACA plans compared to the previous year.
A KFF survey found that while seven out of ten enrollees maintained marketplace coverage, many downgraded their plans or opted to forgo health insurance entirely due to cost. More than half of enrollees reported reducing household spending, including on groceries, or taking on additional work hours. A significant portion is incurring loans or increasing credit card debt to cover healthcare-related costs, and nearly one in five expressed uncertainty about their ability to afford premiums for the entire year.
Individual and Family Financial Impacts
Many individuals and families across the United States are reporting substantial increases in their monthly health insurance premiums:
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Amy Jackson (Butler, Mo.): A 56-year-old medical billing worker, projects her monthly premium to increase from $275 to $1,250 in 2026 without the tax credit. She requires continued coverage for breast cancer follow-up.
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Robert Bixon (Boynton Beach, Fla.): A 61-year-old retiree, anticipates monthly premiums of $4,500 for himself, his wife, and one son in 2026.
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Ezra McKay (Memphis, Tenn.): A 26-year-old part-time bookseller with bipolar disorder, currently paying $15 monthly, projects his premium to increase to $550 monthly, representing nearly half of his income.
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Catriona Johnson (Chapel Hill, N.C.): A 44-year-old social worker with a congenital abnormality, anticipates her premium increasing from $442 to $666 next year, with her deductible rising by $1,000.
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Chris O'Donnell (Richmond, Va.): A 58-year-old freelance business owner, projects his family's monthly cost to increase from $837 to $2,155 for 2026. His wife has diabetes and is a cancer survivor.
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Celeste Jameson (North Port, Fla.): A 41-year-old paralegal, projects her monthly premiums to increase from $266 to $593.
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Kelly Badeau (Tucson, Ariz.): Faces an increase from $94 per month to an estimated $900 for her silver ACA plan in 2026. Her husband may require prostate cancer treatment.
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Genna Boatright (Siren, Wis.): A 40-year-old with rheumatoid arthritis, currently paying $12 monthly, projects her premium to be $700 without the tax credit. She was denied Medicaid coverage.
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Kristine Weidner (Branford, Conn.): A 62-year-old self-employed psychotherapist, anticipates her high-deductible ACA plan increasing from $589 monthly to $1,691 monthly in 2026.
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Robert and Emily Sory (Nashville, Tenn.): Operate an animal sanctuary. 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 also lost her job-based insurance.
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A family in Providence, R.I.: After a job loss, their "gold" plan's monthly premium is projected to increase from approximately $2,000 to nearly $3,000. The parents plan to use retirement savings to cover their $1,200 monthly plan, while their children obtained free Medicaid coverage.
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Cynthia Freeman (61) and Brad Lawrence (52) (Brooklyn, N.Y.): Freelancers whose "silver" plan is projected to increase by nearly 75% to $801 per month. Lawrence's kidney disease requires ongoing medication costing an estimated $760 per month without insurance. Freeman is considering a full-time bartending position to access health benefits.
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Nicole Benisch (Providence, R.I.): A 45-year-old holistic wellness business owner, projects her monthly premium to more than double from $108 to $220. Her plans to marry have been reconsidered due to the financial impact on her insurance eligibility and premiums.
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Adrienne Martin (Texas): Her family's monthly healthcare premium is projected to increase from $630 to $2,400 in 2026. Her husband requires an intravenous medication that costs approximately $70,000 per month without insurance.
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Mathew (Michigan): A 40-year-old with an autoimmune condition, saw his ACA plan premium rise from $181 to over $427 per month. He married his best friend, Christina, to access her employer-sponsored health plan, which now costs him $121 per month.
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A self-employed couple (Manchester, Conn.): Experienced a spike in monthly premiums from approximately $730 in 2025 to over $2,500 in 2026. They have reduced household spending and anticipate potentially utilizing a second retirement fund to manage costs.
Broader Healthcare System Challenges
The increase in uninsured individuals is anticipated to place additional strain on healthcare providers. Hospitals and clinics expect a rise in patients without insurance.
Federally Qualified Health Centers (FQHCs) offer services on a sliding scale based on a patient's ability to pay, though patients still receive bills reflecting their financial capacity. Many FQHCs operate on-site pharmacies, some partnered with the Dispensary of Hope, a Nashville-based nonprofit that distributes donated medications free of charge to uninsured individuals below 300% of the federal poverty limit. Increased demand on these services is anticipated.
The financial strain on hospitals may intensify, particularly in the ten states that have not expanded Medicaid under the ACA.
These non-expansion states, such as Tennessee, contribute to a "Medicaid gap" where 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.