A June forecast from the Congressional Budget Office says up to 4.2 mn Americans would walk away from Affordable Care Act health insurance coverage (frequently called “Obamacare”) without the enhanced credits.
If lawmakers extend them, more than 3.4mn people would gain coverage each year through 2034. That gap alone shows how much these subsidies prop up the system. Maybe too much for comfort.
Consumers could soon face ACA plan choices that trend cheaper on premiums but tougher on deductibles. Someone in a silver plan may slide to a bronze option with a smaller monthly bill and much bigger upfront costs before coverage even starts.
That’s the tradeoff more people might take if pandemic era tax credits disappear at the end of 2025, because the math gets rough fast.
The people with the most to lose include entrepreneurs, according to Small Business Majority. Reopening the government without renewing the expanded subsidies lands a heavy hit on small businesses nationwide.
Farmers, gig workers, and anyone else locked out of employer plans would feel it too, said Georgetown University’s Sabrina Corlette.
Insurers may get stuck with a higher concentration of expensive enrollees if healthier, cost wary people exit the market.
According to our analysts, that’s how risk pools wobble: the healthy leave, the sick stay, prices climb, and the cycle repeats until regulators panic.
For now, ACA consumers stare at rising costs with no clear fix. The bipartisan deal that ended the recent shutdown didn’t solve affordability; it just delayed the decision to December.
Congress will decide then whether to extend the COVID era credits or let them die at the end of 2025.
Corlette warned the uncertainty already pushes younger, healthier people to consider bailing. She said the deal practically guarantees marketplaces lose exactly the kind of enrollees they need to stay stable. And she’s not exaggerating.
KFF estimates that 22mn Americans who receive ACA tax credits will see their monthly premiums more than double on average.
That doesn’t mean the plans themselves doubled in price; it means consumers will pay an extra $1,016 on average in 2026 without the subsidies. Actual numbers vary by age, income, location, and coverage level, but the jump is brutal either way.
Why is this happening?
If Congress greenlights the bipartisan deal, Affordable Care Act tax credits revert to the original 2010 rules. Obama era subsidies capped eligibility at 4x the federal poverty level. During COVID, Congress temporarily juiced those subsidies so more Americans could afford coverage.
Now, without them, anyone earning above 4x the poverty line pays full freight. Lower income buyers still get help, but nowhere near the support they had with the pandemic boosts.
Meanwhile, medical costs continue to rise. Insurers price ACA plans based on care costs and how often people use that care.
For 2026, ACA carriers plan to raise rates an average of 26%, KFF says. That’s the baseline. But the end of pandemic era subsidies makes the consumer hit steeper than the sticker increase alone.
Anyone earning above $62,600 as an individual or $128,600 for a family of four pays the full premium. Anyone below those thresholds gets reduced support, back to the older sliding scale. No fancy cushion. No pandemic bump.
According to our analysts, this is one of those slow rolling policy cliffs where everyone sees the edge coming, no one loves the politics, and the people most exposed brace for costs that jump faster than their income. Congress has a few weeks to decide whether they stop it or let millions absorb the hit.
The Affordable Care Act (ACA) is a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reforms to the health insurance market.
This includes many provisions that are consistent with AMA policy and holds the potential for a better health care system.
The ACA represents a tremendous step forward on the path toward meaningful health system reform, and additional steps will follow.
Under the Affordable Care Act, patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state.
The AMA is committed to providing information for physicians to help their patients get coverage, along with securing changes to improve the law moving forward.
