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La surprime des assurances médicales des états unis vas monter en flèche en raison de l'arrêt des crédits.
Executive Summary
The central claim — that U.S. health insurance premiums will surge if enhanced premium tax credits and related subsidies lapse — is supported across the reviewed analyses, which project large premium increases for Marketplace enrollees and sizable coverage losses if Congress does not act [1] [2] [3]. Estimates vary: some analyses calculate average premium payments more than doubling for subsidized enrollees and a median proposed rate increase of roughly 18–30% for 2026, while others quantify millions becoming uninsured and substantial job impacts tied to reduced healthcare funding [4] [5] [6]. Recent policy reporting from August and September 2025 frames these outcomes as plausible near-term results unless legislative extensions are enacted [7] [4].
1. Why premiums would jump — the subsidy cliff and its mechanics
The primary mechanism driving projected premium spikes is the scheduled expiration of enhanced Affordable Care Act premium tax credits, which in many models restores the pre-2021 “subsidy cliff” and removes cost-sharing protections that have kept net premiums affordable for millions. Analyses show that removing the enhancements would cause Marketplace enrollees’ net premiums to rise dramatically because the marketplaces’ benchmark plans would retain gross costs while taxpayer-funded offsets disappear; one projection shows average subsidized enrollee payments rising 114% from 2025 to 2026 if enhancements expire [3] [2]. The effect is greatest for those whose incomes hover above subsidy thresholds and for older enrollees facing age-based premium differentials, amplifying both the financial burden on individuals and the risk of coverage loss at scale [8] [9].
2. How big the increase might be — divergent numbers, common direction
Different analyses give different magnitudes but all point to substantial increases. The Commonwealth Fund and related modeling report a median proposed premium increase of about 18% nationally and higher in some states, while KFF-style projections and other estimates produce an average doubling of net premium payments for subsidized enrollees and benchmark plan premium hikes of 17–30% depending on state exchange operation [4] [3] [5]. Scenario models tied to the full lapse of enhancements forecast millions more uninsured people, with one estimate citing nearly 5 million newly uninsured in 2026 and another projecting 3.8 million additional uninsured by 2035, indicating wide downstream uncertainty yet consistent upward pressure on premiums and uninsured rates [6] [9].
3. Who would be hurt most — distributional impacts and inequities
The burden concentrates on middle-income households above traditional subsidy cutoffs, older enrollees within the individual market, and communities of color who experienced earlier gains in coverage under the expanded credits. Projections show that hundreds of thousands of enrollees with incomes above 400% of the federal poverty level could face the return of the “subsidy cliff,” producing dramatic premium increases for older people and those with fewer employer options [8] [9]. Modeling also links the expiration to increased uninsured rates among low-income populations and highlights potential job losses tied to lower healthcare spending — an economic ripple that disproportionately affects vulnerable communities and providers in low-margin markets [6].
4. Political context and competing narratives — policy choices matter
Analyses underscore that the projected premium spikes are contingent on legislative decisions; extending or replacing enhanced tax credits is the direct lever to avoid the most severe outcomes. Coverage gains from the enhancements are presented as policy successes by advocates and researchers, while opponents who emphasize fiscal constraints or alternative reforms frame the enhancements as temporary interventions. The One Big Beautiful Bill Act and related congressional debates are cited as potential turning points: policy proposals to repeal or alter enhancements could reverse coverage gains, while bipartisan or targeted extensions would blunt projected premium increases [7] [1].
5. Bottom line for policymakers and the public — windows for action and uncertainty
The evidence across sources converges on a stark conclusion: without congressional action to extend enhanced premium tax credits, Marketplace enrollees face substantially higher premiums and increased risk of becoming uninsured in 2026, with modeled impacts ranging from double-digit percentage premium hikes to average net premium increases over 100% for subsidized enrollees and multimillion-person coverage losses [3] [2] [6]. Timing matters: many projections anchor the fiscal cliff at the end of 2025 and model 2026 consequences, making near-term legislative choices decisive [1] [4]. Policymakers must weigh these modeled health, economic, and distributional effects against fiscal and structural policy priorities; absent action, the data show predictable, measurable worsening of affordability and coverage.