The enhanced subsidies were put into place under the 2021 American Rescue Plan, which made ACA plans affordable for many middle-class families.
The trade-off: While the monthly premiums are typically lower, they’d have to shoulder higher out-of-pocket costs before coverage kicks in.
Of those, more than 9 in 10 — 22.3 million people — qualified for the enhanced subsidies.
Without the enhanced subsidies, the amount the government pays toward their monthly premiums will shrink.
A June report from KFF finds that 3 in 4 adults support extending the enhanced subsidies, including two-thirds of Republicans.
Just $278 a month is all that Leighanne Safford and her husband, Lorry, pay for health insurance. But beginning in January. 1. Their premium might increase to $1,800 per month.
When the enhanced Affordable Care Act subsidies expire at the end of December, millions of people, including Safford’s family, may have to pay hundreds more for their health insurance premiums the following year.
With the implementation of the expanded subsidies under the 2021 American Rescue Plan, many middle-class families were able to afford ACA plans. The 2022 Inflation Reduction Act made the subsidies last until 2025.
However, in neither of the two significant funding bills that have been passed this year, the Republican-controlled Congress extended the subsidies. Republicans may or may not include an extension in a bill to maintain government funding later this month.
The impact on Safford may be exacerbated by the Medicaid expansion rollbacks included in President Donald Trump’s massive legislative package, which was signed into law this summer. The family also plans to pay for Adam’s health insurance in 2026 because she is worried that her 13-year-old son might lose his Medicaid coverage.
The $1,800 monthly premium, which only covers her and her husband, is too expensive, according to Safford, unless they reduce their spending on necessities like food and dental care. As a result, they want to move to a more affordable, high-deductible plan that would provide family coverage. The trade-off is that even though monthly premiums are usually lower, they would have to pay more out of pocket before coverage begins.
“At this time, we’re deciding because all three of us are reasonably healthy,” Safford stated. However, we all know that health can change at any time. “”.
The Affordable Care Act provided health insurance to over 24 million people in 2025, according to data from KFF, a health policy research group. More than nine out of ten of them, or 22.3 million people, were eligible for the increased subsidies. The ACA’s standard subsidies for extremely low incomes, which went into effect in 2014 and are anticipated to remain in place, are also included in that number. ().
In Mississippi, Florida, West Virginia, Oklahoma, Louisiana, Utah, and Alabama, enhanced subsidies were provided to at least 96% of ACA enrollees. The lowest rates were found in Washington state (73 percent) and New Hampshire (71 percent).
According to a 2024 analysis by the Congressional Budget Office, the nonpartisan organization that advises Congress on budget and economic matters, if the enhanced subsidies expire, almost 4 million people are expected to die in 2026 because they cannot afford the premiums. By 2034, that figure is anticipated to soar to nearly 7 million.
Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy, stated that “millions of people will become uninsured” if Congress does nothing. It will be far more expensive without these subsidies. “”.
A twofold blow.
The ACA plans for the following year will open for enrollment in November. 1. .
However, according to Jessica Altman, executive director of Covered California, a state-based marketplace for ACA coverage, many families will experience “sticker shock” in October when official notices detailing the monthly premiums for the upcoming year arrive in their mailboxes.
“There’s a lot of fear,” she stated. That could be someone who has cancer or another chronic illness and knows they need it, or someone who thinks they might have to wait and hope. ‘”.
As an illustration, Altman stated that a family of four in Sacramento County making $113,000 annually might see a monthly premium increase of roughly $1,550 if government subsidies end, as opposed to only $112 if they continue.
States must also account for anticipated increases in insurer premiums the following year, in addition to the subsidies’ expiration.
Altman described it as “a double whammy of premiums going up and then tax credits possibly going down.”. According to a KFF report, insurers that provide ACA plans anticipate raising premiums by an average of about 18 percent nationwide. S. . for 2026. According to KFF, people might have to pay an average of 75% more for premiums when the loss of subsidies is combined with this.
Cynthia Cox, vice president and director of the ACA program at KFF, stated that those who are still eligible for the regular ACA subsidies will also not be exempt. The government’s monthly premium payment will decrease in the absence of the increased subsidies.
According to Cox, “the effects will be fairly widespread.”. Almost everyone who purchases their own health insurance will be impacted in some way by this. “.”.
Dr. David Zonies, who practices in Safford, Washington state, stated that many of his patients will be directly impacted. Zonies serves as the medical director at Harborview Medical Center, a safety net facility at the University of Washington that primarily treats Medicaid and ACA patients.
“Many patients will be left without insurance and postpone necessary care until it becomes much more serious due to the loss of the enhanced subsidies and the Medicaid cuts,” he said.
“The loss of these tax credits is my biggest worry right now,” Zonies stated. “We expect that things will essentially return to how they were prior to the passage of the Affordable Care Act, and that will be absolutely devastating.”. “”.
A request for comment was not answered by AHIP, the primary industry trade association that represents insurers, including those that offer ACA plans.
a battle to increase subsidies.
Park stated that Congress still has the option to extend the increased subsidies, either as a stand-alone bill or as part of a larger government funding package. On September, the most recent government spending bill expires. 30.
According to him, “it is very difficult to predict.”.
Many Republicans remained against the subsidies, while Democrats have persisted in calling for their extension.
However, Senate Majority Leader John Thune, R-S. A. stated to NBC News earlier this month that he is keeping the possibility of an extension open.
Thune stated, “Yes, some of our members are paying attention to it,” but he also criticized Democrats for enacting phaseouts for the subsidies and increasing the program’s size.
Speaker of the House Mike Johnson, R-La. remains ambivalent on the matter, but he has also left the possibility of a funding extension open.
Congress must act swiftly, Altman said, adding that an extension would give many families “peace of mind” as well as financial and health care security.
Two-thirds of Republicans and three out of four adults favor extending the enhanced subsidies, according to a June KFF report.
However, Park stated that the increased subsidies that Republicans passed might differ from the ones that the Democrats had in place before.
He predicted that Republicans in Congress would try to lessen the generosity of the enhanced subsidies if they were willing to negotiate an extension of the enhanced credits.
Like Safford’s family, the majority of families will probably switch to high-deductible plans, but some may choose to maintain their coverage by making financial sacrifices, according to Cox. The purpose of these plans is to protect against catastrophic medical bills, even though members must pay more out of pocket before coverage begins.
Let’s say you get cancer or require some very costly medical care, or you are struck by a bus. You would be protected from those extremely high hospital expenses with that kind of plan, Cox said.
She is still “knocking on wood” that the subsidies will be extended, according to Safford.
If they aren’t extended, “it would take away from our life,” she stated.
