Millions of Americans could see their health insurance premiums climb by a staggering average of 75% next year. Enhanced Affordable Care Act (ACA) subsidies, which have helped lower the cost of marketplace coverage for middle- and low-income households, are set to expire on December 31. Without a healthcare spending agreement from Congress, it is unlikely these subsidies will be renewed.
With open enrollment currently underway, many Americans may be facing a new round of insurance sticker shock. Extending these ACA tax credits has been a key goal for Democrats, contributing to the stalemate at the heart of the recently ended government shutdown. Although the government reopened on November 12 after a record 43 days, lawmakers did not take action on the subsidies. The deal to reopen the government does, however, provide for a fresh debate over the subsidies next month. Additionally, they did not reverse former President Donald Trump’s changes to Medicaid, another priority for Democrats.
For many Americans, this could mean less access to health insurance and higher healthcare costs.
### What to Know About ACA and Medicaid in 2026
Low- and middle-income households are expected to bear the brunt of losing the enhanced ACA subsidies. Passed in 2021 under the Biden administration, the expanded tax credits increased the amount of financial relief available to Americans enrolled in marketplace plans.
Over the past decade, marketplace enrollment has surged from 11 million to more than 24 million. One reason for this growth is that the enhanced subsidies were available to middle-income Americans earning up to 400% of the poverty line—$128,600 for a family of four—making marketplace plans more affordable.
Without these credits, people enrolled in ACA plans could see their out-of-pocket premium costs rise by an average of over 75%, according to an analysis by the Kaiser Family Foundation (KFF). Some enrollees will experience a reduction in financial aid, while others may be disqualified entirely based on their income. For many, premiums could increase by over $1,000 annually.
Beyond the direct loss of enhanced subsidies, many insurers are likely to raise premiums to offset a projected decline in enrollment among healthier Americans. Last year, nearly 20 million Americans benefited from these enhanced ACA subsidies.
### Medicaid Changes and Increased Costs
Medicaid recipients could also face higher healthcare costs. Despite prolonged negotiations and the government shutdown, Congress has not agreed to reverse changes to Medicaid made under former President Trump’s administration through the One Big Beautiful Bill Act.
This legislation introduced new Medicaid eligibility requirements, including a mandate that non-exempt Americans work 80 hours per month to qualify for coverage. Additionally, the law limits the amount of funding states can allocate from provider taxes toward Medicaid.
As a result, hospitals stand to lose funding, and many Medicaid recipients may experience increased out-of-pocket costs over the coming years.
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The expiration of enhanced ACA subsidies and ongoing changes to Medicaid coverage could significantly impact millions of Americans’ access to affordable healthcare in 2026. Keeping informed and reviewing your options during open enrollment will be critical to navigating these changes.
https://www.businessinsider.com/aca-health-insurance-costs-skyrocket-government-shutdown-what-to-know-2025-11