How would letting enhanced premium tax credits expire in 2025 affect marketplace premiums and enrollment for 2026?

1. What the “enhanced” credits did — and why their expiry matters

The ePTCs expanded eligibility (including people above 400% of the federal poverty line) and increased subsidy amounts compared with pre‑2021 rules; Congress extended those enhancements through 2025, so they automatically revert to the older formula in 2026 if not renewed ^[3]. That change alters the formula for required household premium contributions and therefore raises the share of premiums paid directly by enrollees ^[4].

2. How much premiums would rise for current marketplace enrollees

Multiple non‑partisan and policy research groups project big increases: Kaiser Family Foundation estimates average premium payments for subsidized enrollees would jump about 114% (roughly $888 → $1,904 annually) if the ePTCs expire ^[1]. KFF’s interactive calculator and data note also show out‑of‑pocket premium payments would be substantially larger in 2026 compared with 2025 if the enhancements end ^{[5] [6]}.

3. Enrollment impacts — millions could lose subsidies or coverage

The Congressional Budget Office and other analyses foresee sizable enrollment declines. CBO’s projection (cited by Commonwealth Fund and others) estimates marketplace enrollment would fall from about 22.8 million in 2025 to about 18.9 million in 2026 if ePTCs end — a loss of nearly 4 million enrollees in one year ^[2]. Other models (e.g., Urban Institute and Commonwealth Fund summaries) estimate even larger disruptions: some analyses project several million losing marketplace coverage and millions becoming uninsured ^{[7] [8]}.

4. Who would be most affected — geography and income matter

Policy briefs emphasize that middle‑income households (including those above 400% FPL made newly eligible by the enhancements), rural areas, states that didn’t expand Medicaid, and regions with higher premiums would feel outsized effects. The loss of ePTCs disproportionately raises costs where premiums are already high and where Medicaid gaps exist ^{[3] [2]}.

5. How insurers and premiums feed back into each other

Insurers set 2026 rates already accounting for expectations about which consumers will remain enrolled; if many healthier enrollees drop coverage when subsidies vanish, adverse selection could push unsubsidized premiums higher, worsening affordability for remaining buyers (a dynamic noted in insurer filings and policy analyses) ^[9]. That feedback amplifies the direct effect of smaller tax credits on household premium bills ^[9].

6. Fiscal and economic tradeoffs flagged by analysts

Analysts spotlight tradeoffs: letting ePTCs expire reduces federal outlays for subsidies but increases uninsured rates and may shift costs onto hospitals and state safety nets. The Congressional Budget Office and others have quantified both sides — extensions would raise federal deficits over a multi‑year window but expiration would create higher uncompensated care and possible downstream economic effects ^{[4] [10] [8]}.

7. Disagreements, uncertainties, and timing issues

Estimates vary by author, model year, and baseline (e.g., whether they use 2025 enrollment or different premium growth assumptions). Some analyses focus on immediate 2026 impacts (CBO, KFF), while others model multi‑year declines in enrollment and employment shifts. Exact numbers differ — for example, KFF’s premium increase estimate (~114%) and CBO’s enrollment projection (22.8M → 18.9M) are the most‑cited but other groups estimate larger coverage losses ^{[1] [2] [8]}. Timing matters too: insurers have filed 2026 rates based on expectations, so delayed Congressional action could complicate implementation and transitional relief ^[9].

8. What the sources don’t say or leave open

Available sources do not mention precise state‑level premium outcomes for every exchange plan post‑expiry, and they do not provide a single consensus projection for the long‑term distributional effects on employer coverage or labor market shifts — instead, different models produce different magnitudes ^{[3] [8]}. Also, implementation details if Congress later intervenes (timing, retroactivity, or targeted fixes) would materially change outcomes but are outside the described projections ^[9].

Bottom line: all cited reporting and policy analyses agree the ePTC sunset would sharply raise marketplace premium payments for many enrollees and reduce marketplace enrollment by millions in 2026, but exact magnitudes vary by model and assumptions ^{[1] [2] [3]}.