ACA Premium Hikes: Who Faces the Greatest Impact?
Open enrollment for 2026 health insurance coverage under the Affordable Care Act (ACA) has commenced, revealing significant premium increases for millions. The expiration of enhanced premium subsidies, which have provided financial relief since 2021, threatens access to affordable healthcare for many Americans.
Impact of ACA Premium Hikes
The expiration of these subsidies is predicted to have a profound effect, particularly on lower-income individuals, older adults, and middle-class enrollees. A report from KFF, a nonpartisan health policy research organization, indicates that average premium costs may more than double for many families.
Importance of Enhanced Subsidies
- Enhanced tax credits, first implemented by a Democratic-led Congress during the COVID-19 pandemic in 2021, have significantly improved healthcare access.
- In 2025, a record 24 million people signed up for coverage, with over 90% receiving premium assistance.
- Approximately half of policyholders pay $0 or near $0 monthly premiums.
Without these subsidies, the Congressional Budget Office forecasts that an additional 4 million people could become uninsured by 2034. The majority of the current enrollees come from Southern states, where Medicaid expansion has not reached low-income adults.
Regional Concentration of Enrollment
The states showing significant enrollment growth include:
- Texas
- Florida
- Georgia
- North Carolina
These states contribute to nearly half of the increase in coverage since the enhanced subsidies were enacted. Most enrollees reside in areas that favored Donald Trump in the 2024 presidential election or in Republican-led congressional districts.
Political Stalemate Over Subsidy Extension
The discussion surrounding the renewal of these critical subsidies has become a contentious issue on Capitol Hill. With the current government shutdown that began on October 1, 2023, Congress remains divided. Democrats insist any federal funding package must include an extension of the enhanced assistance. Conversely, Republicans refuse to negotiate until the government reopens.
Survey data from late September indicated broad support among Americans for extending the subsidies. However, as the shutdown continues, the backing among Republican voters and Make America Great Again supporters has diminished.
As negotiations progress, the outcome will determine the future of affordable healthcare for millions of Americans, making the implications of potential ACA premium hikes a critical matter in the upcoming discussions.
