Millions of people nationwide are facing higher health insurance costs in 2026 after lawmakers in Congress let enhanced Affordable Care Act (ACA) subsidies lapse, a shift already changing who can keep coverage and what they pay.
The enhanced premium tax credits, which lowered the monthly cost for people who buy health insurance through the Affordable Care Act marketplaces, expired at the end of 2025. As a result, many Obamacare recipients are now facing higher bills, and some middle-income households have lost subsidy eligibility altogether.
What’s concerning is that health policy experts have said the changes could push millions of people out of coverage this year, raising new concerns about access to care and financial strain.
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The ACA subsidies are designed to lower monthly premium costs for people who purchase coverage through state or federal marketplaces. They are paid directly to insurers and reduce what consumers owe each month.
In early January, the House of Representatives advanced a measure to renew the expired subsidies for three years, despite opposition from Republican leadership. The bill is expected to pass the House again, but it faces an uncertain future in the Senate, where a similar proposal failed in December.
Still, a bipartisan group of senators are reported to be close to a compromise bill that could include a shorter extension and changes to the program. A surge in health care costs tied to the subsidy lapse added pressure on legislators as they opened the 2026 session. Lawmakers are also juggling foreign policy votes and a looming January 30 deadline to fund the government or risk a partial shutdown
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What changed in 2026
The expired subsidies were first expanded under the Biden administration and later extended through 2025 by the Inflation Reduction Act. They removed the income cap that previously limited subsidies to people earning up to 400 percent of the federal poverty level and set a limit that households would not pay more than 8.5 percent of their income for premiums.
However, with Congress’s inaction, income caps are back in place for those enrollees. Individuals who earn above 400 percent of the poverty level no longer qualify for premium tax credits. Others now pay a higher share of their income toward monthly premiums.
According to health policy analysts, some enrollees are seeing premium increases of 50 percent or more. And in certain cases, premiums have doubled compared with last year.
An analysis by the Urban Institute and the Commonwealth Fund projected that higher premiums tied to the subsidy expiration could lead about 4.8 million people to drop coverage in 2026. The ACA marketplaces currently cover about 24 million people nationwide.
What people should know now
Even with the enhanced subsidies gone, some financial help remains available. People earning up to 400 percent of the federal poverty level may still qualify for standard ACA subsidies, though the assistance is smaller than in recent years.
Experts recommend that consumers carefully review their options during open enrollment. Switching plans, comparing insurers, or adjusting coverage levels may help reduce costs, though that can mean higher deductibles or fewer benefits.
People who experience major life changes, such as a job loss or drop in income, may qualify for a special enrollment period or additional financial assistance.
Health policy analysts also advise consumers to watch Congress closely. While the subsidies have expired, lawmakers could still act later in the year, potentially restoring some assistance retroactively.
Who is most affected?
Health advocates say the impact of expiring subsidies will fall hardest on Black and brown people, older adults and people living in states that did not expand Medicaid.
Black Americans are more likely to rely on ACA marketplace plans because of gaps in employer coverage and Medicaid eligibility. Subsidies help stabilize coverage for families with fluctuating incomes and reduce the risk of losing insurance during job changes or economic downturns.
Older Americans who are not yet eligible for Medicare may also face sharp premium increases. Some may downgrade their plans, take on higher deductibles, or drop coverage altogether.
Hospitals and community health centers could see higher uncompensated care costs as more patients become uninsured. Rural providers and safety net systems are especially vulnerable, according to health policy experts.
Workers may also feel the effects. As premiums rise, some employers may steer employees toward alternative arrangements such as Individual Coverage Health Reimbursement Arrangements, which require workers to shop for coverage on their own.
Congress stalls on an extension
Democrats have long pushed to extend the enhanced subsidies, warning that letting them expire would raise costs and increase the number of uninsured Americans. In December 2025, House Republicans blocked an effort to force a vote on a three‑year extension ahead of the December 31 deadline.
The ACA premium tax credits were created to make health insurance more affordable for people who do not get coverage through an employer or public program. The enhanced subsidies expanded eligibility and increased the amount of financial assistance available.
