How would loss of enhanced Obamacare subsidies affect premiums and enrollment in 2026?

1. Price shock: How much would premiums rise for consumers?

Analysts diverge sharply on the magnitude of premium increases. KFF’s updated analysis finds subsidized enrollees’ average out‑of‑pocket premium payments would more than double — from $888 in 2025 to $1,904 in 2026, a 114% increase — reflecting both higher list premiums and much smaller subsidies if enhancements lapse ^{[1] [5]}. Several media outlets and calculators repeat that figure as the headline impact on consumers ^{[6] [7]}. By contrast, CBO focuses on “gross benchmark” premiums (before subsidies) and estimates a more modest 4.3% rise in 2026 if the enhanced credits are not extended, though it also expects longer‑term premium pressure thereafter ^[3]. These different metrics — net premiums paid by subsidized enrollees versus gross premiums before subsidies — explain much of the apparent disagreement in the reporting ^{[3] [5]}.

2. Enrollment effects: How many would drop or lose coverage?

Predictions of enrollment loss also vary. The Urban Institute projects a very large contraction: roughly 7.3 million people losing marketplace coverage in 2026, with 4.8 million becoming uninsured and others shifting to alternative coverage, driven by the big jump in net costs ^[2]. The CBO’s earlier estimate was smaller, projecting about 2+ million consumers losing coverage in 2026 if enhanced subsidies expire — a gap that again stems from different behavioral assumptions and modeling choices ^{[3] [4]}. Trade groups and health system advocates have also cited CBO figures (around 2.2 million) to warn of coverage losses, showing how stakeholders pick the projection that best supports their case ^[8].

3. Risk pool and insurer reactions: Why could premiums rise further?

Insurers filed 2026 rate proposals that reflect concern about a healthier cohort leaving the market if subsidies disappear, which would worsen the exchange risk pool and push premiums higher even beyond initial listing increases. State filings cited by the Peterson‑KFF tracker show insurers in some states projecting gross premiums rising roughly 3–7% because healthier enrollees would drop coverage; a few insurers expected minimal changes, highlighting state variation ^[9]. Analysts caution that departures of lower‑cost enrollees concentrate costs on remaining members and can amplify price increases beyond the headline subsidy change ^{[9] [3]}.

4. Who is most exposed — distributional impacts

The loss of the enhanced “caps” that limited premium contributions to as low as 8.5% of income under recent law would particularly hit middle‑income households above prior eligibility cutoffs and older enrollees whose unsubsidized premiums are high; reports show examples where some older consumers could face monthly increases in the hundreds, and in extreme cases thousands annually ^{[6] [10]}. KFF’s interactive tool and other explainers emphasize the distributional nature: some lower‑income people could still receive original PTCs in 2026, while many in the middle would see the biggest sticker shock ^{[5] [11]}.

5. Economic and policy knock‑on effects

Beyond direct enrollee pain, researchers estimate broader economic impacts: the Commonwealth Fund (citing Urban Institute modeling) projects job losses tied to reduced federal spending on subsidies and higher uninsured rates — the Urban estimate warned of nearly 340,000 jobs lost in 2026 from the expiration scenario ^[2]. Policy analysts also note operational frictions: marketplaces and insurers would need to reprogram systems and notify consumers, so even a late congressional fix would take time to restore previous subsidy levels and consumer notices ^[2].

6. Why estimates differ — key assumptions to watch

Differences stem from whether analysts report net payments (after subsidies) or gross premiums; behavioral assumptions about how many people drop coverage; insurer pricing responses; state‑level subsidy policies; and which base year premium projections are used ^{[1] [3] [9]}. KFF emphasizes the immediate consumer cost change net of credits ^[1], while CBO emphasizes actuarial premium changes before subsidies ^[3]. Stakeholders often highlight the estimate best aligned with their priorities — consumer groups stress large enrollment losses, fiscal analysts stress CBO’s smaller gross premium effect ^{[2] [4]}.

Limitations: available sources do not mention projections beyond those cited here (for example, recent legislative fixes or state emergency measures after October 2025) and do not agree on a single unified estimate ^{[1] [3] [2]}. In short, expiration would unquestionably raise consumer costs and put downward pressure on enrollment; how large those changes are depends on whether one looks at net costs or gross premiums and on behavioral and insurer responses ^{[1] [3] [2]}.