Families on Obamacare Brace for Higher Health Care Premiums Next Year

Leighanne Safford and her husband, Lorry, pay just $278 a month for health insurance. But starting January 1, their monthly premium could increase to as much as $1,800.

Safford’s family is among millions who could be forced to pay hundreds of dollars more for their health insurance premiums next year as enhanced Affordable Care Act subsidies expire at the end of December.

The enhanced subsidies were implemented as part of the 2021 American Rescue Plan, which made ACA plans affordable for many middle-class families. The Inflation Reduction Act of 2022 extended the subsidies through 2025.

The Republican-controlled Congress, however, did not extend the subsidies in either of the two major funding bills passed so far this year. It’s unclear whether Republicans will expand them later this month in a bill to keep the government funded.

For Safford, the effect could be compounded by rollbacks to Medicaid expansion in President Donald Trump’s sprawling legislative bill signed over the summer. She worries that her 13-year-old son, Adam, could lose his Medicaid coverage, so the family also plans to pay for his health insurance in 2026.

The enhanced subsidies were implemented as part of the 2021 American Rescue Plan, which made ACA plans affordable for many middle-class families. The Inflation Reduction Act of 2022 extended the subsidies through 2025.

The Republican-controlled Congress, however, did not extend the subsidies in either of the two major funding bills passed so far this year. It’s unclear whether Republicans will expand them later this month in a bill to keep the government funded.

For Safford, the effect could be compounded by rollbacks to Medicaid expansion in President Donald Trump’s sprawling legislative bill signed over the summer. She worries that her 13-year-old son, Adam, could lose his Medicaid coverage, so the family also plans to pay for his health insurance in 2026.

More than 24 million people gained their health insurance through the Affordable Care Act in 2025, according to data from health policy research group KFF. Of those, more than 9 in 10 – 22.3 million people – qualified for the enhanced grants. (This figure includes people who also qualify for the ACA’s standard very low-income subsidies, which took effect in 2014 and are expected to continue.)

In Mississippi, Florida, West Virginia, Oklahoma, Louisiana, Utah, and Alabama, at least 96% of ACA enrollees received enhanced subsidies. New Hampshire and Washington state had the lowest rates, at 71% and 73%, respectively.

If the enhanced subsidies expire, nearly 4 million people are expected to go without coverage in 2026 because they won’t be able to afford the premiums, according to a 2024 analysis from the Congressional Budget Office, the nonpartisan agency that advises Congress on budget and economic issues. This number is expected to reach almost 7 million people by 2034.

If Congress doesn’t act, “millions of people will become uninsured,” said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy. “Without these subsidies, it will be much more expensive.”

Open enrollment for next year’s ACA plans begins November 1.

But for many families, the “sticker shock” will come in October, when formal notices land in their mailboxes outlining next year’s monthly premiums, said Jessica Altman, executive director of Covered California, a state marketplace for ACA coverage.

“There’s a lot of fear,” she said. “Whether it’s someone who has cancer or a chronic condition who knows they need it, or someone who thinks, ‘I might have to pass and cross my fingers.’ “”

In Sacramento County, Altman said that for example, a family of four earning $113,000 a year could see their monthly premium jump about $1,550 if government subsidies expire, compared to just $112 if subsidies remain.

In addition to expired subsidies, states must also take into account expected premium increases from insurers next year.

It’s “a double whammy of premiums going up and then tax credits going down,” Altman said. A KFF report found that insurers that offer ACA plans are projecting an average premium increase of about 18% in the United States for 2026. Combined with the loss of subsidies, people could pay an average of 75% more in premiums, according to KFF.

People who are still eligible for standard ACA subsidies won’t be spared either, said Cynthia Cox, vice president and director of the ACA program at KFF. Without the enhanced subsidies, the amount the government pays toward their monthly premiums will shrink.

“The effects are going to be quite widespread,” Cox said. “Almost everyone who buys their own health insurance will be affected in one way or another.”

At Safford’s Washington state home, Dr. David Zonies said many of his patients will be directly affected. Zonies is the medical director of Harborview Medical Center at the University of Washington, a safety net hospital that cares largely for Medicaid and ACA patients.

The loss of enhanced subsidies, along with Medicaid cuts, means many patients will be uninsured and will delay the care they need until it becomes much more serious, he said.

“The biggest concern I have right now is the loss of these tax credits,” Zonies said. “We anticipate that we’re going to basically go back to what it looked like before the Affordable Care Act was passed, and that’s going to be really devastating.”

A spokesperson for Ahip, the main industry trade group that represents insurers, including those that sell ACA plans, did not respond to a request for comment.

Park said it was still possible that Congress could extend the enhanced subsidies — either as part of a government funding package or a separate bill. The latest public spending bill expires on September 30.

“It’s very difficult to predict,” he said.

Democrats continued to advocate for extending the subsidies and many Republicans remained opposed.

But Senate Majority Leader John Thune, Rs.D., told NBC News earlier this month that he was keeping the door open for a potential extension.

“It’s something that, yes, some of our members are paying attention to,” Thune said, although he blamed Democrats for both expanding the size of the program and including cuts for subsidies.

House Speaker Mike Johnson, R-LA., has been noncommittal on the issue, but he has also kept the door open to a funding extension.

Altman said Congress needs to figure out what it wants to do quickly, noting that an extension would not only provide “peace of mind” for many families, but also security in their health care and their economic freedom.

A June report from KFF found that 3 in 4 adults support extending the enhanced subsidies, including two-thirds of Republicans.

Park said the enhanced subsidies passed by Republicans, however, are not the same as what Democrats had in place before.

“I expect that if there is a Republican willingness in Congress to negotiate an extension of the enhanced appropriations, they may seek to reduce the generosity of the enhanced grants,” he said.

Cox said some families may decide to maintain their coverage by making sacrifices to their household budgets, but most, like Safford’s family, will likely upgrade to higher plans. While people on these plans must pay more out of pocket before coverage kicks in, the plans are designed to protect against huge medical bills that can be financially devastating.

“Let’s say you end up getting hit by a bus, you get cancer or some really expensive medical treatment that you need. That kind of plan would shelter you from those very, very high hospital costs,” Cox said.

Safford said she continues to “knock on wood” that the grants will be extended.

“It would take away our lives” if they are not expanded, she said.