How will ACA subsidy expiration impact health insurance costs in 2026?

1. The headline: Premiums jump and some marketplace costs more than double

Multiple analyses present a consistent headline: if the enhanced premium tax credits lapse, average Marketplace premium payments will surge in 2026. KFF’s estimate in the provided material projects more than a doubling of average premium payments for subsidized enrollees—from roughly $888 in 2025 to about $1,904 in 2026—an increase of 114% that reflects the loss of enhanced subsidies ^{[1] [3]}. The Committee for a Responsible Federal Budget analysis reinforces that post-subsidy premiums would more than double and notes pre-subsidy premiums would also rise by roughly 26%, driven by broader healthcare cost trends and risk-pool shifts ^[2]. These figures align across sources and create a clear quantitative expectation of sharply higher consumer costs if no legislative action occurs.

2. Who bears the brunt: Older and middle-income enrollees face the largest hits

Analyses uniformly identify older adults and those just above prior subsidy thresholds as the groups with the largest increases in absolute dollars and relative affordability problems. KFF and allied reporting emphasize that older middle-income enrollees will face the largest dollar increases because age rating and income thresholds combine to create steep out-of-pocket premium burdens when enhanced credits disappear ^{[3] [4]}. The Bipartisan Policy Center and Harvard-affiliated work included in the package highlight that families and people above 400% of the federal poverty level would become especially vulnerable, as the enhanced structure that previously limited premium shares by income would be gone ^{[7] [8]}. These consistent signals point to a concentrated, predictable distributional effect rather than a uniform across-the-board increase.

3. Coverage and system effects: Millions could lose coverage, insurers feel strain

The analyses indicate both immediate enrollee effects and system-wide repercussions. Several pieces estimate up to about 4 million people could lose Marketplace coverage or become uninsured over the next decade absent extension, and roughly 20–22 million people currently receive enhanced subsidies who would face higher costs or churn ^{[4] [5] [8]}. The Congressional Budget Office–linked summary and other analyses foresee a rise in uninsured rates and reduced federal spending if subsidies lapse, which would also affect insurer financial stability and provider uncompensated care burdens ^{[6] [4]}. The Committee for a Responsible Federal Budget quantifies federal cost trade-offs—noting that extensions cost substantial sums over a decade—highlighting the fiscal policy choices behind coverage outcomes ^[2].

4. Money and politics: Cost of extension versus fiscal trade-offs

Analyses quantify the fiscal trade-offs and political choices underlying any decision to extend subsidies. The enhanced subsidies cost roughly $138 billion in 2025 and extending them would be estimated at approximately $350 billion over ten years, according to the Committee for a Responsible Federal Budget summary ^[2]. That fiscal framing explains why some lawmakers and budget-minded analysts favor allowing expiration to reduce federal outlays, while advocates stress the coverage and affordability harms for millions. The Congressional materials and Bipartisan Policy Center analysis present these as explicit policy trade-offs: immediate consumer protections versus long-term budgetary impact, a framing that shapes legislative debates and helps explain bipartisan differences on whether to extend, trim, or redesign the credits ^{[6] [7]}.

5. Divergent framings and what’s omitted: Projection uncertainties and short-term versus long-term impacts

While projections converge on large premium and coverage effects, the analyses differ in emphasis and omit some uncertainties. KFF and media-adjacent reports stress acute consumer pain and specific dollar estimates for 2026, while budget-focused analyses emphasize decade-long fiscal costs of extension ^{[1] [2]}. Fewer of the provided pieces fully model behavioral responses—such as whether some enrollees would switch to employer coverage, drop coverage entirely, or take up Medicaid in eligible states—creating uncertainty about the precise uninsured increase and insurer risk pools ^{[5] [8]}. The materials also focus on Marketplace enrollees and fiscal aggregates but give less attention to regional variation in plan availability, state-level policy responses, and potential market adjustments by insurers that could mitigate or amplify price effects ^{[4] [9]}.