- Enhanced ACA marketplace subsidies expired on Jan. 1, 2026, raising average subsidized premiums about 114% (roughly $888 to $1,904 a year) for 22–25 million people.
- Without an extension, an estimated 4.0–4.8 million more people could become uninsured in 2026, with millions more losing coverage annually through 2034.
- Premium shocks hit low- and moderate-income enrollees hardest, especially in non–Medicaid expansion states, while households above 400% of the poverty level lose all subsidy eligibility.
- Spillovers include more uncompensated care and provider revenue losses, plus broader economic damage such as job losses and higher financial strain on families.
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As of January 1, 2026, the enhanced premium tax credits under the ACA, first established by the American Rescue Plan and extended via the Inflation Reduction Act, have officially expired. These enhanced subsidies had reduced premium costs significantly for millions, amplified marketplace enrollment, and lowered financial barriers for low-income households.
The expiration’s most immediate impact is projected to be dramatic premium increases: health insurance premiums for subsidized ACA enrollees are expected to rise by an average of 114%, from about $888 annually in 2025 to $1,904 in 2026. In some states, the increase could exceed that average by a wide margin.
Coverage losses follow. Between 4.0 and 4.8 million additional people could become uninsured in 2026 alone if the enhanced subsidies are not restored. If inaction continues through 2026–2034, up to 3.8 million people may lose insurance annually.
The effects are unevenly distributed. Low-income individuals—especially those earning up to 200% of the federal poverty level—face the greatest exposure. In 10 states that didn’t expand Medicaid, many relied heavily on ACA subsidies; the policy shift thus threatens to widen existing disparities. Households above 400% FPL face losing all subsidy eligibility, exposing them to full premium spikes.
Beyond individual hardships, institutional and economic spillovers loom large. Health care providers are slated to lose over $30 billion in revenues and face billions in unpaid bills from uncompensated care. State economies may shed an estimated 340,000 jobs in 2026 due to coverage loss. Families with children, many in nonexpansion states, risk higher costs and reduced access.
Politically, the issue remains a flashpoint. While the House passed a bill for a three-year subsidy extension, the Senate has been resistant. Absent a bipartisan agreement, states may turn to temporary measures to offset federal pullbacks—but these patchworks may prove insufficient to prevent broader disruption.
Supporting Notes
- Enhanced subsidies were expanded in 2021 and extended until end of 2025 via federal legislation; they made ACA premiums more affordable for about 22–25 million people, most of whom received financial assistance to reduce premiums.
- Without the enhanced credits, annual premium payments average will rise from $888 in 2025 to approximately $1,904 in 2026 for subsidized enrollees — a 114% increase.
- If enhanced subsidies expire, 4.0 to 4.8 million people projected to become uninsured in 2026.
- The CBO projects roughly 2.2 million consumers will lose insurance in 2026 if enhanced subsidies end, and about 3.8 million per year from 2026–2034.
- Households above 400% FPL will lose all subsidy eligibility; in many states average premium payments would more than double.
- Health providers could lose over $32 billion in revenue and see $7.7 billion in uncompensated care due to the subsidies’ expiration.
- Economically, roughly 340,000 jobs are estimated to be lost across the U.S. in 2026 if enhanced tax credits are not extended.
- Children and parents make up ~40% of nonelderly marketplace enrollees, and among those projected to become uninsured, 453,000 are children.