Fact check: How would ending enhanced ACA subsidies in 2026 affect health insurance premiums and enrollment in 2026?

1. Clear claims: what analysts and articles actually assert, in plain language

Multiple sources assert three linked outcomes if enhanced subsidies expire: premiums rise, financial assistance falls, and enrollment declines. Journalistic summaries and KFF modeling report average national premium increases between 18% and 26% for 2026, with some insurer filings anticipating even larger proposed increases; advocacy pieces and online calculators emphasize that individual family circumstances can produce far higher percentage increases, potentially doubling what some households pay ^{[1] [2] [3]}. Analyses also assert distributional effects: older adults with incomes just above subsidy thresholds and middle-income families face outsized harms. The Congressional Budget Office’s counterpoint frames the policy choice differently: extending subsidies costs hundreds of billions but would increase coverage by millions, implying that ending subsidies produces both fiscal savings and coverage losses ^[4].

2. The debate over how big premium jumps will be — median versus maximum stories

Estimates vary by methodology and the counterfactual used. KFF and Peterson-KFF examined insurer filings and modeling and find average premium changes in the 18–26% range; these averages reflect weighted market pictures and assume some insurer behavior already anticipates subsidy expiration ^{[1] [2]}. By contrast, calculators and illustrative cases spotlight specific households where gross premiums spike far more than averages: a few profiles and calculator outputs show premium increases exceeding 100% for certain family types or age-income combinations, particularly where subsidies currently cap payment shares of income ^[3]. The difference stems from focusing on mean market effects versus worst-affected individuals and from whether results present gross premiums or net premiums after remaining assistance.

3. How many people might lose coverage — a contested but consequential number

Enrollment impact estimates range in framing: insurer filings and KFF note that many assisted enrollees would see smaller net protection, while advocacy pieces and the CBO project aggregate coverage losses in the millions if subsidies are rolled back. One article cites up to 4 million potentially losing coverage and rising uninsured rates, while the CBO estimates that extending the expansion would raise insured counts by 3.8 million by 2035—implicitly suggesting that ending enhancements would reverse large portions of that coverage gain ^{[5] [4]}. These figures differ because some analyses model near-term behavioral responses to premium changes, while others use long-run microsimulation of policy scenarios; both approaches find material declines in coverage concentrated among subsidy-eligible but price-sensitive households.

4. Who bears the brunt — age, income, and state differences

All sources converge that the burden is uneven. Older adults near the 400% of federal poverty line cutoff and middle-income families are repeatedly highlighted as facing steep increases in gross premiums and hence net affordability shocks. KFF’s reports and calculators show state-by-state variation tied to whether a state runs its own exchange and whether state-level assistance supplements federal credits; one summary notes state exchange enrollees could see lower average increases than federally run exchange enrollees, reflecting existing programmatic differences ^{[2] [6] [3]}. The advocacy piece emphasizes that older couples and families with incomes just above subsidy eligibility could face catastrophic premium bills, amplifying concerns about adverse selection and market destabilization ^{[5] [6]}.

5. Insurer pricing behavior and market stability: insurers are already planning for the change

Insurer rate filings and industry commentary embedded in several analyses show companies are pricing 2026 products with the expiration scenario in mind, producing proposed increases that partially reflect expected subsidy removal. Studies report some insurers proposing hikes up to 59% in certain markets, and aggregate filings point toward an average marketplace premium rise near 18%—partly attributable to anticipated higher net financial exposure for enrollees and potential shifts in the risk pool if lower-income, healthier people drop coverage ^{[1] [7]}. That insurer response creates a feedback loop: expected subsidy removal drives higher prices, which drives enrollment losses, which can further raise insurers’ risk mix, increasing the chance of additional premium pressure absent policy changes.

6. Uncertainties, tradeoffs, and what’s omitted from many headlines

Key uncertainties matter: behavioral responses to premium changes, state-level mitigations, insurer entry or exit, and how quickly Congress or states might act are all decisive but poorly predictable. Several analyses emphasize fiscal tradeoffs—CBO numbers show extending credits is costly (hundreds of billions) but yields coverage gains—yet many journalistic pieces emphasize immediate household impacts without quantifying budget effects ^{[4] [5]}. Headlines stressing “doubling” of premiums capture dramatic worst-case household examples, while averaged actuarial estimates present a less extreme but still significant increase; both perspectives are accurate for different audiences, and the policy choice reflects a tradeoff between near-term affordability and long-term federal budget priorities ^{[3] [1] [4]}.