Which states will see the largest premium increases if 2026 ACA subsidies end?
Executive summary
States with already-high pre-subsidy premiums and older marketplace enrollee mixes stand to see the largest sticker shock if enhanced ACA premium tax credits expire at the end of 2025: analyses and insurer filings point to especially large impacts in states such as West Virginia, Wyoming, Vermont, Alaska and Connecticut, and insurers’ rate filings suggest an average additional premium rise of roughly 4–18% tied to expected subsidy expiration (examples: 7%+ in Vermont filings; median projected 18% in one joint analysis) [1] [2] [3] [4].
1. Why some states would be hit harder — a simple mechanics lesson
Premium tax credits are tied to local benchmark premiums; when the enhanced credits expire, people pay a higher share of premiums and some higher-income (or healthier) enrollees would drop coverage, leaving a sicker, more expensive risk pool and higher gross premiums — CBO projects gross benchmark premiums would rise (4.3% in 2026 under one estimate) and insurers expect morbidity and enrollment effects that push premiums up further [2] [5] [6].
2. Which states analysts single out for the biggest increases
Reporting and policy analysis identify states with high pre-subsidy premiums or older enrollee populations as most vulnerable: HealthInsurance.org’s state-by-state review lists West Virginia, Wyoming, Vermont, Alaska and Connecticut among states where older enrollees and high baseline premiums amplify the loss of enhanced assistance [1]. Peterson‑KFF insurer filings in Vermont, Oregon, Washington and D.C. show insurers explicitly adding roughly 4% on average to 2026 rates for the expected expiration, with Vermont insurers forecasting about 6.6–7.1% additional upward pressure [3].
3. What insurer filings reveal about geographic variation
Insurer rate filings are an early, imperfect signal: a subset of filings across 19 states and D.C. shows insurers adjusting rates to account for healthier people leaving and other regulatory changes; filings cited morbidity adjustments (e.g., Connecticut’s Anthem noting a 3.7% morbidity impact) and insurer-specific add-ons tied to subsidy expiration — these filings imply non‑uniform state impacts depending on local premiums, enrollment mix, and whether states add their own subsidies [5] [3].
4. Quantifying the likely changes — averages mask variation
National estimates and calculators show big average effects but wide state spread: KFF’s interactive work suggests average out‑of‑pocket premium payments would more than double for subsidized enrollees (about a 114% increase nationally in one update), but that average conceals states where pre‑subsidy premiums are much higher and where losses could be far worse for specific age/income combinations [7] [8] [9].
5. Who’s most exposed within those states
Older enrollees (50s–60s), households above 400% of the federal poverty level, and people in states that do not top up federal subsidies face the steepest increases; HealthInsurance.org’s breakdown highlights older people in high‑cost states as bearing the biggest financial shock because they lose the added subsidy protections entirely [1] [10].
6. Competing estimates and limitations in the record
Estimates diverge: CBO’s modeling points to a moderate average gross premium increase (about 4.3% in 2026 in one CBO-derived figure and ~5% pre-subsidy premium push in other summaries), insurer filings and joint analyses (Peterson/KFF or Peterson Institute/KFF) show insurer-level projections ranging up to a median 18% gross increase in some forecasts, and state filings have insurer‑specific assumptions that produce a patchwork of outcomes [2] [4] [3] [6]. Available sources do not provide a single definitive, state‑by‑state ranked table of projected premium increases for all 50 states.
7. Policy context and caveats readers should know
Many numbers assume no congressional action; if Congress extends or modifies the enhanced credits, outcomes change and marketplaces would need reprogramming, which complicates timing for open enrollment [2] [11]. Some states already mitigate the hit — Vermont, for example, has additional state-funded subsidies that reduce the local effect — and filings reflect that state-level policy choices matter [3] [1].
8. Bottom line for readers and policymakers
The clearest pattern in the sources: states with high pre-subsidy premiums and older enrollee mixes (examples named in reporting: West Virginia, Wyoming, Vermont, Alaska, Connecticut) will experience larger premium increases if enhanced tax credits lapse; insurer filings and federal analyses both anticipate meaningful, but uneven, premium pressure across states, and the precise ranking will depend on state premiums, enrollee age/income profiles and whether states step in with their own support [1] [3] [2].
Limitations: this piece relies solely on the provided analyses, insurer filings and policy summaries; available sources do not include a comprehensive, fully comparable 50‑state ranking of projected premium increases under subsidy expiration [3] [2].