Health care costs remain one of the top concerns for American families, and 2026 is shaping up to be one of the worst years yet. Americans with employer-sponsored insurance are facing the largest premium increases in 15 years, while those with Affordable Care Act marketplace plans are bracing for the steepest premium increases since 2018. Combined with rising out-of-pocket expenses, these costs will further strain household budgets and push comprehensive coverage out of reach for many.
At a time when families need relief, the Trump administration and congressional Republicans through the “Big Beautiful Bill” (BBB) have been pursuing and enacting policies that make health care even more expensive. Rather than lowering costs, their agenda eliminates financial assistance, makes historic cuts to Medicaid, increases deductibles, and drives premiums higher.
Here are five ways policies under the Trump administration are increasing health care costs across the country.
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Expiration of the Affordable Care Act’s enhanced premium tax credits
Since 2021, enhanced premium tax credits, first enacted under the American Rescue Plan Act and later extended by the Inflation Reduction Act, have lowered premiums for millions of people who purchase coverage on their own. By boosting financial assistance and expanding eligibility to more middle-income families, the enhanced tax credits for Affordable Care Act (ACA) marketplace plans contributed to record enrollment of more than 24 million Americans in 2025.
If the enhanced tax credits expire at the end of 2025 as currently slated to happen, families will face steep cost increases in 2026. Without the tax credits, KFF projects that net marketplace premiums will rise by an average of 75 percent. Some families will see even larger increases: A family of four (40- and 38-year-old parents of two children) earning $129,000 a year (413 percent of the federal poverty level) would see their monthly premiums for a silver plan increase from $914 to $1,575, an annual increase of $7,935. Given such significant premium increases, many families will be unable to maintain coverage. The nonpartisan Congressional Budget Office (CBO) estimates that 4.2 million more people will be uninsured by 2034 if Congress allows the enhanced tax credits to expire.
During the budget reconciliation process, House Republicans on the Ways and Means Committee rejected an amendment to extend the enhancements beyond December 2025. With 2026 marketplace open enrollment approaching, immediate congressional action is needed to extend the enhanced premium tax credits.
The Big Beautiful Bill’s health care cuts will increase uncompensated care
The BBB’s health care provisions will leave millions uninsured, increase uncompensated care costs for hospitals and other health care providers, and increase the risk of provider closures that leave patients with fewer options and longer travel times for care.
The BBB will rip coverage from Medicaid enrollees who cannot meet new work-reporting requirements. It also blocks reforms that would have lowered out-of-pocket costs for low-income Medicare beneficiaries. The CBO projected that BBB changes alone would result in 10 million more uninsured Americans by 2034. Previous Center for American Progress analysis of an earlier House-passed version of the bill projected that uncompensated care costs would increase by $36 billion by 2034. These costs do not disappear and will ultimately be borne by health care providers. Absorbing uncompensated care costs is likely to be particularly difficult for rural hospitals already strained by tight finances. In September 2025, Augusta Medical Group announced the closure of three clinics across rural Virginia in response to the BBB.
New regulations are raising the cost of marketplace coverage
In June 2025, the Centers for Medicare and Medicaid Services (CMS) finalized the marketplace integrity and affordability rule. Although the agency framed it as a safeguard against “improper enrollments and the improper flow of federal funds,” in practice the rule raises the cost of coverage for millions of Americans who rely on the marketplaces for coverage.
The rule’s eligibility and affordability changes are expected to shrink enrollment. CMS estimates that between 750,000 and 2 million fewer people will have marketplace coverage in 2026. CMS also acknowledged that the rule’s changes would reduce enrollment among healthier individuals, weakening the risk pool and pushing premiums higher for those who remain insured.
In August 2025, a federal judge issued a stay on six of the rule’s provisions, temporarily halting some of the most damaging changes. But unless policymakers stop these changes, marketplace coverage will be harder to access and less affordable for American families.
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New regulations are increasing deductibles by up to $900 for families with employer coverage
In addition to increasing costs for people with ACA marketplace coverage, the Trump administration rule allows all private health plans, including those for the nearly 165 million people with employer-sponsored insurance, to have higher deductibles and other cost-sharing. Families with employer coverage could pay an additional $900 in cost-sharing in 2026 because of this rule.
Tariffs are increasing health insurance premiums
Rising health insurance premiums are also being driven by the Trump administration’s chaotic tariff policy and the uncertainty it creates. A Georgetown University Center on Health Insurance Reforms analysis of marketplace regulatory filings showed that insurers across multiple states have cited tariffs, including those expected on prescription drugs, as a factor in their proposed 2026 rates. United Healthcare called out the impact of tariffs in its filings across multiple states. In Oregon, tariffs accounted for 2.7 percent of the insurer’s proposed 2026 premium increases.
Conclusion
The Trump administration is pursuing an agenda to increase premiums, drive millions off coverage, and shift costs back onto providers and patients. By letting the enhanced premium tax credits expire, slashing Medicaid and Medicare, imposing harmful marketplace rules, and raising costs through tariffs, the administration will make care less affordable and less secure for millions of Americans. The Trump administration and Congress must change course to protect coverage and affordability and to ensure that working families are not left to pay more for less care.
The author would like to thank Emily Gee and Christen Linke Young for their contributions to this analysis and Kierra Jones for their fact checking.