House Republicans’ recently passed reconciliation bill—the One Big Beautiful Bill Act (OBBBA)—would significantly raise health care costs for millions of Americans who rely on the Affordable Care Act (ACA) marketplaces. A new analysis from the Center for American Progress finds that young adults with modest incomes would be hard hit compared with their higher-income peers. For example, a single 28-year-old earning around $39,000 per year, equivalent to 250 percent of the federal poverty level (FPL), would see their benchmark silver premium costs nearly double from $1,565 to $2,868, while someone making $63,000 (401 percent of the FPL) would see a 12 percent decrease. The impact varies sharply by geography. Using the example of a 28-year-old, in 16 states, average bronze plan premium costs for young adults making $39,000 per year would rise by more than 500 percent, while their higher-income counterparts making around $63,000 would see more modest—albeit still significant—increases of between 0 percent and 100 percent across most states. These disparities highlight how the OBBBA would shift more of the premium burden onto lower-income young adults, while sparing or even benefiting most young adults with higher incomes—deepening inequities in access to affordable care and forcing those with the least financial flexibility to pay the most.
The American Rescue Plan Act of 2021 made ACA coverage more affordable by increasing premium tax credit amounts and expanding premium tax credit eligibility to include more middle-income households. For the first time, no marketplace enrollee eligible for premium tax credits had to pay more than 8.5 percent of their income toward benchmark premiums. When passing the OBBBA, House Republicans rejected an amendment to extend these enhancements beyond December 2025.
The OBBBA also includes a provision (Section 44202) that resumes federal reimbursements for cost-sharing reductions (CSRs), which lower out-of-pocket costs for low-income marketplace enrollees. This would effectively reverse a premium pricing practice known as “silver loading” that began in 2018 after the Trump administration halted federal reimbursement of CSRs. Since insurers were still required by law to provide CSRs, most states responded by “loading” the cost of CSRs onto silver-tier premiums. Premium tax credits are tied to the price of silver plans, so this shift made the tax credits more generous, allowing many people to purchase free bronze plans or more affordable gold plans. Reversing silver loading would lower the sticker price of silver plans—but in doing so would also shrink the value of premium tax credits, causing net premium costs to rise for millions. Initial text from the Senate Health, Education, Labor, and Pensions (HELP) Committee confirms that Senate Republicans propose codifying this provision in their version of the OBBBA, though the plan is undergoing changes in light of recent guidance from the Senate parliamentarian on whether the text complies with Senate rules, and it is unclear whether the CSR provision can be modified and able to remain in the final legislation in a similar form.
Young adults with modest incomes will face sharp premium increases
If the OBBBA becomes law, young adults with low and modest incomes would face much higher increases in ACA marketplace premium costs than their higher-income peers. A single 28-year-old earning around $39,000 per year (250 percent of the FPL) on a benchmark silver plan would, on average, see their annual premium costs almost double from $1,565 to $2,868—an 83 percent increase. Premium costs would rise from consuming about 4 percent of their income to nearly 7 percent. If that 28-year-old wanted to switch to a more affordable bronze plan to save costs, their premium costs would still rise by almost 48 percent. A 28-year-old who wants to keep their more affordable bronze plan could on average see their premium costs jump from about $380 to approximately $2,300—a staggering 507 percent increase. That would represent premium costs rising from less than 1 percent to almost 6 percent of annual income. Gold plans would also become substantially more expensive for that 28-year-old, with costs rising 116 percent.
In contrast, young adults with higher incomes would see smaller increases—or even reductions—in what they pay for ACA marketplace premiums. At 300 percent of the FPL (around $47,000 annually), the average premium cost increases for a single 28-year-old remain significant: Bronze plans rise by 115 percent, silver plans by 44 percent, and gold plans by 64 percent. As a share of income, bronze plan premium costs would rise from 3.5 percent to 7.5 percent, silver plans from 6 percent to 8.7 percent, and gold plans from about 6.2 percent to 10.2 percent of income—substantial increases across the board. However, single young adults earning roughly $63,000 annually (401 percent of the FPL) would on average see no change in bronze or gold plan costs and would remarkably see a 12 percent drop in silver premium costs.
Young adults with modest incomes could see premium costs rise by a staggering 500 percent or more in many states
Across the board, CAP’s analysis finds that premium cost increases will hit lower-income young adults harder than those with higher incomes. But the size of those increases varies dramatically depending on where a young adult lives. For example, bronze plan premium costs for a single 28-year-old earning around $39,000 per year (250 percent of the FPL) would rise by more than 500 percent in 16 states. In three states, premium costs for bronze plans for a 28-year-old would on average increase by more than 1,000 percent: in Nebraska from about $190 to about $2,200; in Alabama from about $40 to about $2,000; and in South Dakota from about $40 to about $2,100—a staggering 4,720 percent increase in premium costs. In an additional 23 states, a 28-year-old would see hikes ranging from 200 percent to 500 percent. Gold plan premium costs would also increase steeply for that 28-year-old: In 31 states they could see cost hikes of 100 percent to 200 percent. On average, silver plan premium costs for a 28-year-old would increase by a more moderate but still significant 83 percent across all states.
Conclusion
The OBBBA, combined with the expiration of the enhanced premium tax credits for ACA marketplace plans, would dramatically raise marketplace premium costs for young adults with low and modest incomes. This will likely price many young adults out of coverage they can afford today.
Methodology
To assess the impact of expiring enhanced premium tax credits and the reversal of silver loading on ACA marketplace premium costs for single young adults age 28, the authors began with state average 2025 premiums for a 40-year-old by metal tier from KFF and adjusted them for age using the standard age curve from the U.S. Centers for Medicare and Medicaid Services for all states except New York and Vermont, where premiums do not vary by age. To model premiums after silver-loading reversal, the authors reduced benchmark silver plan premiums by 12 percent, in line with May 2025 Congressional Budget Office (CBO) projections, and held bronze and gold plan premiums constant. While states vary in how they implement silver loading, this analysis assumes a uniform 12 percent downward adjustment as a result of the OBBBA.
To estimate what older adults would pay in premiums in 2025 if the enhanced premium tax credits were not extended, the authors used CBO and Joint Committee on Taxation projections of what premiums net of subsidy would be in 2025 based on the original ACA marketplace subsidy schedule. Income as a share of the FPL was calculated using the 2025 poverty guidelines published by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, including separate guidelines for Alaska and Hawaii.
The House-passed bill included a provision (Section 44202) that prohibits the use of CSR funds for health plans that cover non-Hyde amendment abortions. Initial text from the Senate HELP Committee confirms that Senate Republicans propose codifying this provision in their version of the OBBBA, though the plan is undergoing changes in light of recent guidance from the Senate parliamentarian on whether the text complies with Senate rules, and it is unclear whether the CSR provision can be somewhat modified and able to remain in the final legislation in a similar form. Due to significant uncertainty around the policy and how states will react to the restriction, this analysis does not account for its potential impact.
This analysis does not account for the impact of the Trump administration’s recently finalized marketplace integrity and affordability rule, which will go into effect in 2026 and is expected to marginally lower marketplace premiums while increasing cost sharing.