Expert predictions on health insurance costs without ACA 2026?

1. Sticker price vs. what consumers pay — two different stories

Insurers’ proposed rate filings indicate median or average increases in the underlying (pre‑subsidy) premiums for 2026 in the high teens to mid‑20s percent — Peterson‑KFF reports a median proposed rise of about 18% and an average insurer increase “about 20%,” while KFF’s national figure is roughly 26% ^{[1] [3]}. But what many consumers actually owe depends on whether enhanced premium tax credits survive; if they expire, the portion enrollees pay out‑of‑pocket will rise much more than these sticker increases alone imply ^{[1] [3]}.

2. The subsidy cliff: who gets hit and how badly

Several state analyses and national outlets show that without the 2021‑era enhanced credits, people who had been paying small premiums or zero could face large new monthly bills — Covered California projected an average additional $125/month and a 97% average increase for subsidized enrollees; other state examples show some households facing 20%–100% hikes or even much larger percentage jumps depending on income and local rate filings ^{[4] [6] [5]}. Insurer and carrier guidance also notes that subsidies would revert to pre‑2021 amounts if Congress does not act ^{[7] [8]}.

3. Coverage losses and macro effects — the numbers

Analysts at the Urban Institute and Commonwealth Fund estimate that nearly 4.8–5 million people could lose marketplace coverage in 2026 if enhanced credits lapse; the Commonwealth Fund brief warns that premiums “will soar for millions more” and ties coverage loss to broader economic effects such as job losses in some scenarios ^[2]. The Congressional Budget Office previously warned of millions more uninsured in projections cited by news outlets and state analysts ^[4].

4. Risk‑pool dynamics: why premiums could climb further

Brookings and other analysts explain the feedback loop: if subsidies end and many healthier enrollees drop coverage, insurers expect a sicker risk pool and priced that into 2026 filings — which added a few percentage points to rate requests because insurers anticipated healthier people leaving ^{[9] [1]}. CMS says some regulatory changes could instead lower premiums modestly (about 5% on average) by addressing improper enrollments, but that is a separate policy lever discussed alongside subsidy debates ^[10].

5. Geographic and demographic variation — local markets matter

National averages mask big local swings: filings in some states show 12%–27% typical insurer changes, but individual counties or exchanges (e.g., New Jersey, California, West Virginia examples) show much larger average consumer increases and insurer exits that reduce plan choice ^{[1] [4] [6]}. Lower‑income and moderate‑income households near subsidy eligibility cutoffs are especially vulnerable ^{[7] [11]}.

6. Competing narratives and political stakes

Advocates for extending credits emphasize coverage and affordability harms — higher premiums, millions losing insurance, and economic spillovers — while critics argue expanded subsidies were costly and invited fraud or improper enrollments; CMS’s rulemaking frames some actions as restoring “Marketplace integrity” and saving taxpayer dollars ^{[2] [10]}. Reuters highlights how the subsidy debate is becoming a high‑stakes midterm issue in specific districts ^[6].

7. What experts say individuals should watch and do

Reporting and insurer guidance urge people to preview 2026 prices on exchanges, compare total plan costs (premiums plus deductibles and networks), and be ready for tighter eligibility verification and changing enrollment windows; many carriers and consumer guides stress early shopping and tax reconciliation requirements to preserve eligibility ^{[8] [11] [7]}. Analysts also warn that even if Congress acts late to reinstate subsidies, insurers already priced 2026 with expectations of the lapse, which can blunt the benefit of a last‑minute fix ^[9].

Limitations: reporting to date focuses on filings, state previews, and model estimates rather than final nationwide consumer bills; available sources do not mention definitive post‑2026 legislative outcomes, and projections vary by model and geography ^{[1] [2]}.