Thousands of voters in key Republican districts could face a sharp rise in health‑insurance costs when the Affordable Care Act’s enhanced premium tax credits expire on Dec. 31. The potential spike has become a political flashpoint as GOP lawmakers weigh the cost of extending the credits against their 2026 electoral prospects.
The Stakes for Republicans
The impending expiration threatens to double premiums for many Americans who rely on subsidies to keep health coverage affordable. In 2025 the average premium was $888; it could jump to $1,904 in 2026—an increase of 114%. In the Allentown‑area district represented by Rep. Ryan Mackenzie, the average rise could reach 178%, according to state data.
Mackenzie, whose narrow 1‑point victory (about 4,000 votes) last year made his seat one of the most competitive in the country, has repeatedly stated his support for an extension. “I think that we need to deal with the reality of where we are now and even if you have a broken system, that doesn’t mean that you shouldn’t provide or offer relief to individuals who are dealing with those high costs right now,” he said in an interview with the Associated Press.
The Republican majority in the House depends on retaining control of the chamber in the 2026 midterms. GOP leaders see the credit’s expiration as a potential liability that could be leveraged by Democrats to galvanize voters in swing districts.
Bipartisan Efforts and GOP Division
A bipartisan group of lawmakers has been pushing for a last‑minute compromise. The group, which includes 13 Republicans—among them Mackenzie—sent a letter to Speaker Mike Johnson in late October. The letter urged a temporary extension, warning that letting the credits lapse “without a clear path forward would risk real harm to those we represent.”
Johnson has not committed to a short‑term extension vote before Jan. 1 and has dismissed the looming premium increases as affecting a small percentage of Americans. The lack of a clear timeline has left many Republican districts uncertain.
U.S. Rep. Jen Kiggans, R‑Va., a sponsor of the bipartisan proposal, emphasized the human impact. “I have 40,000 people in my district who rely on this health care and doing nothing to prevent a spike in their premiums is wrong,” she said.
Other GOP members have introduced separate bills. Rep. Kevin Kiley, whose district was redrawn to favor a Democrat, proposed a two‑year extension that would cap income eligibility to exclude higher earners. Kiley said the current system isn’t working, but there isn’t enough time to make systematic reforms before millions of Americans “just suddenly pay double on their premiums.”
Rep. Jeff Van Drew, R‑NJ, also introduced a temporary extension bill. He warned that letting the subsidy lapse would hurt Republican prospects in the midterms. “People say, ‘well, it’s not that many people,’” Van Drew said. “The kind of election we’re going to have in the midterms in multiple districts is going to be decided by one or two points. It’s going to be close. It’s going to be tight, and it does matter. It absolutely matters politically.”
Rep. Richard Hudson, chair of the House Republicans’ campaign arm, countered that the tax credits would not be “decisive” in next year’s election when other issues are likely to dominate voters’ minds.
The Numbers Behind the Credit
The enhanced premium tax credits were added and then extended under Democratic President Joe Biden when his party held the majority in Congress. They are a key component of the ACA’s subsidy program, which currently covers more than 24 million people—including farmers, business owners and other self‑employed individuals who lack employer‑based coverage.
If the credits are not extended, the Congressional Budget Office projects that 3.8 million more people will be uninsured by 2035. At the same time, extending the credits would raise the deficit by $350 billion over the next decade.
In Mackenzie’s district, more than 20,000 people received the enhanced tax credits in 2025. The district’s narrow margin of victory last year underscores how even a small shift in voter sentiment could alter the seat’s partisan balance.
Impact on Constituents
For many constituents, the impending change is already a reality. Patrick Visconti, a 59‑year‑old landscaper and bus driver, switched to a low‑premium, high‑deductible plan because he could not afford to keep his current plan, which would more than double from under $200 to over $500 a month. Visconti said the plan he chose is “crappy coverage.” “I’d rather pay the $200 a month. But I can’t get anything for $200,” he said.
Lynn Weidner, a home‑care worker who works nearly 80 hours a week, faces a premium jump from $400 to $680. She has an iron deficiency and other conditions that require regular medical care. “So I’m trying to find places where I can cut money so that I can afford my insurance come January, which is stressful,” Weidner said.
The stories of Visconti and Weidner illustrate the personal cost of the credit’s expiration and provide a human face to the policy debate.
Political Calculations
Democratic leaders are positioning the issue as a key campaign theme. Rep. Suzan DelBene, chair of the House Democrats’ campaign arm, said swing‑district Republicans cannot distance themselves from the expiration. “The number one issue across the country is affordability and health care is a key part of that,” she said.
Within the GOP, members are divided over how to proceed. Some, like Kiggans and Mackenzie, are pushing for a compromise that includes reforms such as rooting out insurance broker fraud and reducing subsidies for higher earners. Others, like Kiley and Van Drew, emphasize the urgency of a short‑term extension to protect voters and maintain electoral advantage.
Candidates challenging Mackenzie in the upcoming primary have highlighted the issue. Democrat Ryan Crosswell called rising insurance costs a “breaking of promises” by Trump, Republicans and Mackenzie. Carol Obando‑Derstine described the impending expiration as a “crisis of (Mackenzie’s) own making.”
Mackenzie has repeatedly clarified that he does not control the House agenda. “I am not the speaker, I don’t set the calendar or the agenda. I’m not the leader, I can’t call up bills,” he said.
Key Takeaways
- The ACA’s enhanced premium tax credits will expire Dec. 31, potentially doubling premiums for many Americans.
- Republican lawmakers in swing districts are divided between seeking a temporary extension and pursuing broader reforms.
- The policy’s extension could raise the deficit by $350 billion, but its loss could leave 3.8 million more people uninsured by 2035.
- Personal stories from constituents in Mackenzie’s district highlight the immediate financial strain caused by the credit’s expiration.
The debate over the credit’s fate will continue to shape the 2026 midterm election landscape, as both parties weigh the political costs and benefits of extending or withdrawing subsidies.
