Which states currently receive the largest ACA subsidy amounts per enrollee and how would that change if 2026 enhancements expire?
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Executive summary
States with lower benchmark premiums and large enhanced credits tend to get the biggest subsidy-per-enrollee boosts today; analyses show enhanced credits added roughly $76 per member per month on average across HealthCare.gov states in 2025 and produce much larger proportional value in low-premium areas (Milliman) [1]. If the ARP/IRA enhancements expire at end of 2025, federal rules would revert and average enrollee premium payments would more than double nationally — KFF estimates an increase from $888 in 2025 to $1,904 in 2026 (114%) — and many states and age/income groups would see large absolute and percentage declines in subsidy amounts [2] [1].
1. Which states now receive the largest subsidy amounts per enrollee — the broad pattern
Analysts report that enhanced premium tax credits can deliver higher dollar-value subsidies in places where underlying benchmark premiums are higher for certain ages and in lower-premium areas the enhanced subsidies can represent a larger percentage of the benchmark premium; Milliman finds enhanced subsidy value “skew[s] higher in lower premium areas” while also noting value falls with age, and across HealthCare.gov states 2025 enhancements averaged about $76 PMPM for a 40-year-old [1]. KFF and other trackers show the value varies by zip code, age and income and that state-level variation is driven by local premiums and demographics [2] [1].
2. Why lower-premium states can show the biggest proportional gains
Milliman and other calculators demonstrate that where benchmark premiums are low, an identical percentage-based subsidy converts into a bigger share of the net premium and therefore can look like a larger “boost” relative to cost; Milliman: “enhanced subsidy value as a percentage of benchmark premium can skew higher in lower premium areas” [1]. KFF’s interactive tools and state filings reviewed by the Peterson‑KFF tracker also show subsidy impact depends on zip code-level premiums and insurer rate assumptions [2] [3].
3. Which populations and states would lose most if enhancements expire
Multiple analyses say older enrollees and those above 400% of FPL would be hit hard if enhancements end — the original ACA formula reintroduces a “subsidy cliff” at >400% FPL and increases required contribution rates [4] [5]. KFF finds average premium payments would rise 114% nationally from $888 to $1,904 if enhancements expire [2]. Milliman flags significant disenrollment risk and uneven geographic effects, with higher absolute PMPM losses in higher-premium areas but higher percentage effects in low-premium areas [1].
4. Evidence from insurer rate filings and early state data
Insurer filings in several states (Vermont, Oregon, Washington and DC) attribute roughly a 4 percentage‑point additional premium increase on average to the expected expiration of the enhanced tax credits; KFF and Peterson‑KFF used those filings as early indicators that 2026 premiums will reflect both underlying cost pressures and policy uncertainty [3] [6]. Insurers and regulators are pricing multiple scenarios into 2026 rates, which amplifies state-by‑state differences [7].
5. Quantifying the national scale and what it implies for states
KFF’s national estimate—average enrollee premium payments jumping from $888 to $1,904—gives a stark headline number but masks state variation; Milliman’s PMPM figures (about $76 PMPM extra value for a 40‑year‑old across HealthCare.gov states) show the enhancements’ dollar impact differs by age and place [2] [1]. CBPP and Urban Institute/CBO projections of coverage losses (millions could lose coverage) further indicate that some states would experience sharper enrollment drops and market disruption if subsidies revert [8] [9].
6. Competing perspectives and political context
Advocates and Democrats pushed extensions arguing the credits cut average premiums and boosted enrollment; KFF, CBPP and others quantify the benefits and risks of expiration [2] [8]. Some Republicans favor other approaches (e.g., HSA payments) and oppose open-ended extensions; reporting around December 2025 shows Congress was divided and decisions were political, not purely actuarial [5]. Available sources do not mention a single definitive state list ranked by per‑enrollee subsidy today; they instead provide calculators and PMPM averages that let users derive state‑level results [1] [10].
7. What you can do next (data tools and caveats)
To see which specific states and zip codes receive the largest per‑enrollee subsidies today or how totals change in 2026, use KFF’s calculator and local insurer filings—KFF’s interactive tool and Milliman’s analyses are the sources the reporting relies on [2] [1]. Limitations: publicly released studies provide PMPM averages, rate‑filing snapshots and models rather than a single authoritative ranked state list; state outcomes will depend on 2026 premiums, enrollee ages/incomes, and any congressional action [3] [1].
Closing note: the best available public reporting shows the enhanced credits materially increased subsidy value and state outcomes vary; if Congress allows the enhancements to expire, federal reversion will cut subsidy amounts and raise net premiums nationwide, with uneven state‑level fallout depending on local premiums and population age/income mix [2] [1].