What are the projected increases in healthcare premiums for states with high ACA enrollment?

1. Sticker shock across the country: headline premium increases

Insurers’ filings and KFF analyses show benchmark ACA premiums rising markedly for 2026 even before accounting for subsidy changes: KFF and multiple press outlets report an average increase in premiums of roughly 26% nationally for 2026 filings, with variation by marketplace type and state ^{[1] [3] [4]}.

2. The far larger impact is on what consumers actually pay

Analysts distinguish “premiums” (what plans charge) from “premium payments” (what consumers pay after tax credits). KFF finds that, if the enhanced premium tax credits expire at year‑end, the average Marketplace enrollee’s out‑of‑pocket premium payments would grow by 114%—from about $888 in 2025 to $1,904 in 2026—because the subsidies that lowered monthly costs would vanish ^[2].

3. Why some states will feel it worse: enrollment, marketplace type, and reinsurance

Rate changes vary widely: state‑based marketplaces generally have contained increases more than HealthCare.gov states, and MoneyGeek’s state analysis shows population‑weighted gross premiums rising about 20% nationally with eleven states seeing increases above 30%, concentrated in the South ^{[5] [3]}. States with high enrollment and fewer reinsurance or affordability buffers are more exposed to both sticker price hikes and the subsidy cliff ^{[5] [6]}.

4. Insurer expectations and the “death spiral” dynamic

Insurers priced rates assuming enhanced credits might expire and that some healthier enrollees would drop coverage. That expectation—fewer low‑cost enrollees remaining—raises underlying premiums further ^{[6] [7]}. Commentators warn that these dynamics risk a market feedback loop where higher premiums drive out healthy enrollees, pushing prices yet higher ^{[4] [7]}.

5. Real‑world examples and consumer consequences

Reporting and interviews document dramatic individual impacts: policyholders have reported monthly premium notices jumping from tens of dollars to several hundred or more, and some patients say the increases threaten their ability to afford coverage or treatment ^[8]. Medicare Rights Center and advocacy groups warn that rate increases combined with subsidy lapses could double costs for many and raise the uninsured count ^{[9] [10]}.

6. The budget and policy context that produced the risk

The enhanced premium tax credits were enacted in 2021 and extended through 2025 by later legislation; they expanded subsidy eligibility and made coverage affordable for many, helping Marketplace enrollment roughly double from 11.2 million in early 2021 to about 23–24 million in 2025. Those enhancements are scheduled to expire at the end of 2025 unless Congress acts, creating the principal policy cliff driving the projected consumer cost increases ^{[2] [10] [11]}.

7. Areas of disagreement and uncertainty in current reporting

Sources agree on the direction—substantial increases—but differ on magnitude and framing: KFF highlights a 114% increase in net payments if subsidies expire ^[2], while other outlets cite a 26% average rise in premiums already filed for 2026 ^{[1] [3]}. MoneyGeek’s state‑level analysis gives a somewhat lower national weighted increase (~20%) but emphasizes wide state variation and greater pain in the South ^[5]. Available sources do not mention exact, uniform state‑by‑state dollar impacts beyond those specific analyses; state‑level outcomes depend on marketplace type, reinsurance, and enrollment mixes ^{[5] [6]}.

8. What to watch next — policy choices that change the picture

Congressional action to extend or modify enhanced tax credits would materially reduce consumers’ out‑of‑pocket increases; conversely, letting the enhancements lapse would deliver the large consumer payment spikes KFF projects and could raise uninsured numbers per CBO and advocacy analyses ^{[2] [10]}. State actions—like reinsurance programs or marketplace design—will also blunt or amplify local effects ^{[5] [6]}.

Limitations: this summary draws only on the supplied reporting and analyses; it does not attempt to model individual household impacts or produce a complete 50‑state table beyond the cited MoneyGeek and KFF work ^{[5] [2]}.