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How would removing the ACA affect premiums for individuals and families in 2026?
Executive summary
Removing the Affordable Care Act’s (ACA) enhanced premium tax credits (or letting them expire) would sharply raise marketplace premiums in 2026 — analysts project average net premium payments could more than double (KFF: ~114% average increase or a 75% gross rise; calculator estimates ~$1,016/year in increased out‑of‑pocket premiums) [1] [2] [3]. Multiple research groups project millions could lose coverage and employers, insurers and state markets would feel spillovers if subsidies end (Urban Institute/CBO/Commonwealth Fund estimates of 4.8–7.3 million losing marketplace coverage and up to ~4.8 million becoming uninsured; job and market effects noted) [4] [5].
1. What the headline numbers mean: big jumps for typical enrollees
KFF and other trackers say the “average” marketplace enrollee will face large increases in net premium payments in 2026 if enhanced premium tax credits are not continued — KFF’s interactive work shows average premium payments rising about 114% (roughly $1,016/year on average) and other summaries report a roughly 75% average gross premium jump (about $700/year) driven by subsidy loss plus insurer rate increases already proposed for 2026 [1] [2] [3].
2. Who is hit hardest: age, income, and family examples
Analyses illustrate uneven effects: older enrollees and those above prior subsidy cutoffs face the steepest dollar hits. KFF models a 60‑year‑old couple at 402% of the federal poverty level paying more than $22,600 extra in 2026 after proposed insurer rate filings — turning a benchmark plan into a very large share of income [3]. KFF’s calculator and Peterson‑KFF work also show middle‑income households (including those just above 400% FPL) and many in the 100–250% FPL bands would see major relative increases [1] [6].
3. Why premiums rise: two forces at once
Two mechanics drive the shock: [7] the policy change — expiration of enhanced premium tax credits raises required household contribution caps (CBPP models a required contribution of ~8.87% of income without enhancements vs ~4.56% if extended) — and [8] insurers’ own rate increases for 2026 (median proposed increases near 18% have been reported), producing compound effects on what families actually pay [6] [3].
4. Coverage and market spillovers: more uninsured, sicker risk pools, and economic effects
Research groups warn that many will drop marketplace coverage when premiums jump. Urban Institute and Commonwealth Fund projections estimate millions could lose marketplace coverage and several million become uninsured in 2026, with secondary impacts on insurer risk pools and the broader economy (Commonwealth Fund cites nearly 5 million newly uninsured and ~340,000 jobs lost in one scenario) [4] [5]. CBPP and CHIR note insurers expect enrollment declines and higher morbidity among remaining enrollees, which could push premiums higher still [5] [9].
5. State and regulatory complications that amplify the effect
Beyond the national subsidy question, recent federal regulatory changes and state‑level filings matter. The Trump administration’s ACA marketplace rule and other changes are projected to reduce premium tax credits and raise out‑of‑pocket costs for many; CMS estimated that these rules alone could cause 750,000–1.8 million to lose marketplace coverage in 2026, concentrated in specific states [10]. Early rate filings and state regulator warnings suggest premiums already reflect expectation of subsidy changes [5].
6. Competing framings and political context
Advocates and consumer groups emphasize the affordability crisis and urge Congress to extend credits to avoid “sticker shock,” framing extension as modest federal cost to prevent widespread coverage loss [2] [4]. Some lawmakers argue alternative approaches or fiscal tradeoffs; available sources do not detail a clear, unified conservative replacement that would prevent the projected premium surge [11]. Reporting notes the timing is politically salient ahead of 2026 elections, which shapes incentives on both sides [2] [11].
7. Practical takeaways for individuals and families
If enhanced credits lapse, many households should expect significantly higher net premiums in 2026 and should shop early, verify incomes, evaluate plan types (including silver plans with cost‑sharing reductions), and check eligibility for Medicaid or employer coverage alternatives; insurers and marketplaces have already posted 2026 premium estimates in many places [1] [12] [5]. Anthem’s guidance similarly flags that subsidies “will still be available” but amounts may be lower under current rules, underscoring that outcomes depend on whether Congress or agencies change policy [13].
Limitations and final note: available sources focus on the likely effects of letting the enhanced premium tax credits expire (and on pending federal regulatory shifts). They quantify large average premium increases and substantial coverage losses but show ranges and state/age/income variability; precise household impacts depend on finalized 2026 rates, geography, ages, family size, and any last‑minute legislative action [1] [3] [6].