What are the projected coverage and premium impacts if enhanced ACA subsidies are not extended beyond 2025?

1. Coverage shock: millions at risk of losing marketplace coverage

Analysts and federal models converge on the conclusion that expiration would shrink marketplace enrollment by several million people — the CBO projected a drop from about 22.8 million enrollees in 2025 to 18.9 million in 2026 and continuing lower thereafter — a decline driven by people who cannot afford much higher premiums and who would either switch to skimpier plans or go uninsured ^[2]; other reporting cites CBO estimates of roughly 4 million more uninsured over the coming decade if enhanced subsidies disappear ^[4].

2. Premiums for consumers: a near‑doubling of average out‑of‑pocket premiums

KFF’s modeling finds the average subsidized enrollee’s premium payment would more than double — rising 114% from $888 in 2025 to an average of $1,904 in 2026 — meaning roughly a $1,016 annual increase for the average person if enhanced credits lapse ^{[1] [5]}. Multiple outlets corroborate that many households would face increases in the ballpark of $1,000 a year, with steeply larger increases for some ages and income brackets cited by the Bipartisan Policy Center and others ^{[6] [7]}.

3. Insurer pricing and market dynamics: modest pre‑subsidy rate pressure plus adverse selection

Beyond the immediate consumer shock, analysts expect some rise in pre‑subsidy premiums — the CBO and budget analysts estimate roughly a 5% increase in underlying (pre‑subsidy) premiums as healthier, lower‑cost enrollees drop coverage and risk pools worsen — a mechanism that amplifies but does not fully account for the consumer premium spike ^[3]. Observers warn that plan selection shifts toward cheaper, higher‑deductible plans would concentrate sicker enrollees in richer plans and could strain insurer finances and networks in some markets ^{[8] [9]}.

4. Who bears the burden: wide but uneven distribution of impacts

Most marketplace enrollees receive subsidies — CMS reported roughly 92% in 2025 — so tens of millions could see higher payments; those above 400% of the federal poverty line would lose eligibility entirely and face the largest relative shocks, while lower‑income households would see smaller but still meaningful increases ^{[10] [11]}. Examples underscore the range: a family of four at ~140% FPL that had $0 premiums in 2025 could face roughly $1,607 a year in 2026 under expiration scenarios, and older, higher‑income enrollees could face very large absolute increases ^{[7] [10]}.

5. Political and fiscal trade‑offs shaping the debate

Policy choices are framed by competing agendas: Democrats pushed temporary expansions to increase coverage and affordability, while some Republican proposals have favored limited alternatives (HSA payments, targeted amounts) with verification strings attached — measures Democrats oppose — and the JCT and CBO quantify sizable fiscal costs to permanently extending the enhanced credits even as extension would avert coverage losses ^{[12] [11]}. Reporting from multiple outlets notes that looming legislative stalemate and holiday recess timing risk locking in 2026 premiums before Congress acts ^{[13] [12]}.

6. The bottom line: predictable harm, uneven severity, and policy choices that matter

The evidence assembled by KFF, CBO, Commonwealth Fund and other analysts is consistent: letting enhanced ACA subsidies expire would predictably cause large increases in consumer premium payments (on average about $1,000 annually and a 114% jump for subsidized enrollees), reduce marketplace enrollment by millions, and modestly raise pre‑subsidy premiums through adverse selection — but the magnitude for any individual depends on age, income, family size, and geography, and the final outcome will reflect unfinished political decisions and potential mitigating proposals ^{[1] [2] [3]}.