ACA health subsidies expire, leaving millions facing sharply higher premiums in 2026

Enhanced tax credits that reduced health insurance costs for more than 20 million Affordable Care Act enrollees expired at midnight Wednesday, beginning 2026 with premium increases averaging 114% for subsidized participants, according to an analysis by the health care research nonprofit KFF.

The lapse ends a pandemic-era program that at its peak allowed lower-income enrollees to obtain coverage with no monthly premiums and capped costs at 8.5% of income for higher earners. Congress failed to pass an extension before the deadline despite months of legislative attempts, though four centrist House Republicans joined Democrats to force a vote on a three-year renewal as early as this month.

The expiration affects people who purchase coverage on the individual market and do not receive insurance through an employer or qualify for Medicaid or Medicare — a group that includes self-employed workers, small business owners, farmers, and ranchers. With 24 million total ACA enrollees, health analysts have predicted the higher premiums will drive many younger and healthier participants to drop coverage altogether.

An analysis conducted last September by the Urban Institute and Commonwealth Fund projected the higher premiums would prompt approximately 4.8 million Americans to drop coverage in 2026, potentially leaving the program with a costlier, sicker pool of remaining enrollees. Because open enrollment in most states continues through January 15, the final effect on participation is yet to be determined.

Costs rising steeply for many enrollees

Some families are facing increases that have multiplied several times over. Katelin Provost, a 37-year-old social worker and single mother, said her monthly premium payment is rising from $85 to nearly $750.

“It really bothers me that the middle class has moved from a squeeze to a full suffocation, and they continue to just pile on and leave it up to us,” Provost said. “I’m incredibly disappointed that there hasn’t been more action.”

Provost said she is holding out hope that Congress acts early in the year. If it does not, she said, she plans to drop her own coverage while keeping her four-year-old daughter on the plan — she cannot afford coverage for both at current prices.

Others are absorbing the increase at a cost. Stan Clawson, a 49-year-old freelance filmmaker and adjunct professor in Salt Lake City, said his premium will rise from just under $350 a month to nearly $500. Clawson, who lives with paralysis from a spinal cord injury, said the added expense is a financial strain but one he will take on because he requires consistent coverage.

Months of legislative attempts fell short

The subsidies were created in 2021 as a temporary measure to help Americans through the COVID-19 pandemic. Democrats extended them, moving the expiration date to the start of 2026. After Republicans cut more than $1 trillion in federal health care and food assistance through a tax and spending package, Democrats repeatedly called for the subsidies to be renewed. Republicans in power acknowledged the issue but declined to bring it to a vote until late in the year.

In December, the Senate rejected two partisan bills: a Democratic proposal to extend the subsidies for three years and a Republican alternative that would instead direct Americans toward health savings accounts. Democrats forced a 43-day government shutdown over the issue. President Donald Trump offered what was described as a possible path forward before reversing course after backlash from conservatives, according to the Associated Press.

In the House, four centrist Republicans broke with GOP leadership and joined with Democrats to compel a vote that could come as soon as this month on a three-year extension of the credits. But with the Senate having already rejected a comparable plan, the prospects for passage remain unclear.

Chad Bruns, a 58-year-old ACA enrollee in Wisconsin, said lawmakers from both parties have failed to address the underlying drivers of health care costs.

“Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it,” Bruns said. “They need to get to the root cause, and no political party ever does that.”

The expiration comes at the start of a midterm election year in which affordability — including health care costs — ranks among voters’ leading concerns, according to the Associated Press.