At a Glance
- Expanded subsidies expired overnight, raising costs for millions.
- Premiums for 20 million subsidized enrollees projected to rise 114 % in 2026.
- A January House vote may restore subsidies, but outcome uncertain.
- Why it matters: People without employer or Medicaid coverage face steep hikes, affecting midterm voters.
The expiration of expanded Affordable Care Act subsidies overnight has left more than 20 million enrollees staring at a 114 % jump in premiums for 2026. A House vote in January could bring relief, but political gridlock leaves many uncertain.
Impact on Health Coverage Costs
The subsidies, first introduced in 2021 to help Americans through the COVID-19 pandemic, were extended by Democrats to the start of 2026. With the expansion, lower-income enrollees had no premiums, high earners paid no more than 8.5 % of income, and middle-class eligibility widened.
On average, 20 million subsidized enrollees face premium hikes of 114 % in 2026, according to a KFF analysis. These increases come amid a broader rise in U.S. health costs, pushing out-of-pocket expenses higher for many plans.
Affected groups include:
- self-employed workers
- small business owners
- farmers
- ranchers
Freelance filmmaker Stan Clawson pays about $350 a month for premiums last year; the cost will climb to nearly $500 next year. Single-mom Katelin Provost’s monthly payment jumps from $85 to almost $750.
The surge in premiums may drive a significant portion of the 24 million total ACA enrollees-especially younger, healthier Americans-to drop coverage. An Urban Institute and Commonwealth Fund study projects that 4.8 million could forgo insurance in 2026.
| Person | Premium (2025) | Premium (2026) |
|---|---|---|
| Stan Clawson | $350 | $500 |
| Katelin Provost | $85 | $750 |
The open enrollment window ends on Jan 15 in most states, leaving final enrollment effects uncertain.
The issue sparked a 43-day government shutdown when Democrats forced action. Moderate Republicans sought solutions to protect their 2026 political prospects, while President Trump floated a plan that was later withdrawn after backlash.
House Speaker Mike Johnson called the expiring subsidies a “boondoggle” as the shutdown approached its two-week mark.
House Speaker Mike Johnson said:
> “boondoggle”
Katelin Provost said:
> “It really bothers me that the middle class has moved from a squeeze to a full suffocation, and they continue to just pile on and leave it up to us.”
Chad Bruns said:
> “Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it.”
Many enrollees feel lawmakers lack understanding of the rising costs and call for subsidies to be restored alongside broader reforms.
Key Takeaways
- Subsidies expired, pushing premiums up 114 % for 20 million enrollees.
- A January House vote could restore them, but uncertainty remains.
- Up to 4.8 million Americans may drop coverage in 2026.
The expiration leaves millions grappling with higher costs, while a House vote in January offers a slim chance of relief.
