As the federal government nears a shutdown, a central issue in the government funding fight is health care costs. Premium tax credits (PTCs) help lower the cost of comprehensive insurance coverage for more than 20 million people who buy health insurance on their own through the Affordable Care Act marketplaces. However, the enhanced level of financial support that has been in place since 2021 will expire at the end of this year, and Congress passed up multiple opportunities to extend it as part of the Big Beautiful Bill signed into law in July. Unless Congress approves legislation on the enhanced subsidies, millions of Americans will face higher costs as a result. The nonpartisan Congressional Budget Office projects that about 4 million more Americans will be uninsured by 2034 if enhanced PTCs are not renewed.
Ahead of the annual open enrollment period, which begins November 1, insurers have been sending rate notices to consumers about 2026 premium increases. Earlier this year, insurers had proposed a median 18 percent increase in premiums for next year, citing higher medical costs, a sicker risk pool due to the enhanced subsidy expiration, and other factors. However, because of the scheduled expiration of enhanced financial help at the end of 2025, the relative increases in premium costs that millions of consumers will face is even greater. Drawing from previously published analysis by the Urban Institute, the Center for American Progress shows the projected increase in the average premium for marketplace enrollees with financial assistance will be roughly 136 percent nationally and above 300 percent in some states if enhanced PTCs expire.
The amount of financial assistance an eligible household receives depends on the premiums for those seeking marketplace coverage and household income. (KFF’s interactive calculator offers more precise estimates of the premium tax credit available with and without the enhanced subsidies for a given household composition and geographic location.) The Urban Institute last year simulated the premium cost increases that enrollees who currently receive financial help would face if enhanced PTCs expired and provided the average premium by state under scenarios with and without enhanced PTCs. While the full 2026 marketplace plan and premium data are not yet available from states and the U.S. Department of Health and Human Services, the Urban Institute’s estimates represent a close approximation of the cost increases that subsidized enrollees—whose level of financial help is linked to household income—would face.
The Urban Institute estimated that among subsidized enrollees, the annual 2025 premium was $460, though without the enhanced tax credits it would have been $1,087 even if enrollees were to switch into the lowest-cost plan within their chosen metal tier.
The Urban Institute estimated that among subsidized enrollees, the annual 2025 premium was $460, though without the enhanced tax credits it would have been $1,087 even if enrollees were to switch into the lowest-cost plan within their chosen metal tier. That represents a 136 percent increase. In other words, the average premium net of financial assistance would more than double if enhanced PTCs are not extended. These increases in the average net premium would vary by state, with some states seeing even higher increases:
- In Alaska, the average premium cost among enrollees with financial assistance will increase 346 percent, or $909 annually.
- In California, the average premium cost among enrollees with financial assistance will increase 122 percent, or $1,000 annually.
- In Florida, the average premium cost among enrollees with financial assistance will increase 132 percent, or $521 annually.
- In Mississippi, the average premium cost among enrollees with financial assistance will increase 314 percent, or $602 annually.
- In Texas, the average premium cost among enrollees with financial assistance will increase 289 percent, or $459 annually.
Unless Congress acts swiftly, millions of Americans who purchase their health care coverage on the individual market will experience sticker shock when they reenroll for 2026 coverage or receive their first bill for next year.
The author thanks Kennedy Andara and Brian Keyser for research assistance.