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What estimates do CBO and Kaiser Family Foundation give for GOP subsidy changes?
Executive Summary
The core claims: the Congressional Budget Office projects roughly 4 million more uninsured people if enhanced ACA premium subsidies lapse, while the Kaiser Family Foundation warns average marketplace premiums could more than double in 2026 for subsidized enrollees and that extending enhanced credits would cost the federal government roughly $350 billion over the coming decade. These estimates come from multiple CBO and KFF analyses published across 2025 and 2024–2025 and reflect different scopes—coverage impacts, premium cost changes, and budgetary costs—so apparent differences stem from what each organization measured and the timeframes used [1] [2] [3] [4].
1. What advocates and reports are actually claiming — pull the claims apart and read the fine print
Analyses circulating in late 2025 distill two headline claims: the CBO projects about 4 million additional uninsured people if enhanced premium tax credits expire, and KFF finds that without those credits average subsidized enrollees’ premiums could rise 114% from $888 in 2025 to $1,904 in 2026. Reporters and advocates often bundle these numbers together, but the two figures answer different questions: CBO focuses primarily on population coverage effects over a span of years, while KFF emphasizes immediate premium-payment impacts for enrollees in the ACA Marketplace. Both point to significant disruption, but one speaks to the number of people uninsured and the other to out-of-pocket premium burdens for current marketplace enrollees [1] [3].
2. The CBO’s bottom line: coverage and budget effects over a decade
The Congressional Budget Office’s analyses in 2025 frame subsidy changes in terms of coverage shifts and federal deficits. CBO estimates show roughly 4 million more uninsured next year if enhanced subsidies lapse, and other CBO work ties specific policy changes—such as permanently adopting enhanced credits or nullifying regulatory rules—to multi-year budget effects like a $349.8 billion increase in deficits from 2026–2035 for a permanent expansion of premium tax credits and a $40.3 billion effect for regulatory reversals. These estimates reflect CBO’s statutory remit to model coverage and budgetary consequences across a multi-year window and emphasize macroeconomic and enrollment trajectories rather than single-year premium spikes [1] [4].
3. Kaiser Family Foundation: who pays more, who loses coverage, and at what cost
KFF’s work zeroes in on consumer-level premium burdens and short-term enrollment effects. Their analyses project that without extended enhanced credits, average subsidized enrollees would face a 114% jump in annual premium payments in 2026, from $888 to $1,904, and that losing the subsidies would produce millions more uninsured—figures KFF and related reporting put at about 4.2 million in some narratives. KFF also calculates the fiscal cost of extending enhanced credits—on the order of roughly $350 billion over the coming decade—framing the extension as a tradeoff between near-term affordability for enrollees and long-term budgetary commitments [3] [2] [5].
4. Why the numbers look different: scope, timing, and methodological choices
Differences between CBO and KFF stem from what each organization counts, which year they highlight, and which policies they model. CBO frames long-term enrollment and budget impacts, often modeling alternative, legislated expansions or regulatory actions and reporting effects across a 10-year budget window; KFF emphasizes immediate plan-level premium impacts and consumer costs for the next open-enrollment year. The CBO’s deficit figures and enrollment projections are produced under formal budget modeling conventions; KFF’s premium calculations combine claims data, plan designs, and behavioral assumptions about take-up and eligibility. Reporters sometimes conflate the CBO’s multi-year budget framing with KFF’s 2026 premium projections, creating the impression of disagreement where there is principally different emphasis [4] [3] [2].
5. Political stakes and interpreting the policy tradeoffs beyond the headlines
Both analyses feed into a high-stakes political debate: extending enhanced credits reduces premiums and likely prevents millions from becoming uninsured, but it carries a substantial federal price tag that fiscal hawks highlight. Polling cited by KFF shows broad public support for extension across party lines, complicating purely partisan narratives. Lawmakers advocating expiry point to budgetary impacts and seek offsets, while proponents stress imminent consumer pain and state-level economic harms if subsidies lapse. Readers should treat the CBO and KFF figures as complementary inputs: CBO frames the long-run budget and enrollment arc, KFF quantifies immediate consumer-facing cost shocks and projected uninsured increases, and together they outline the tradeoffs policymakers face when weighing subsidy extensions versus deficit concerns [2] [6] [7].