WASHINGTON — Concerns are growing among healthcare advocates, insurers and policy researchers that more Americans could become uninsured in 2026 following changes to Affordable Care Act (ACA) marketplace subsidies that took effect after enhanced federal assistance expired at the end of 2025.
The enhanced premium tax credits, first introduced during the COVID-19 pandemic and later extended through 2025, reduced insurance costs for millions of marketplace enrollees. Their expiration has led to higher premiums and out-of-pocket costs for many consumers purchasing coverage through ACA exchanges, according to data from the nonprofit health policy organization KFF and the Centers for Medicare & Medicaid Services (CMS).
KFF reported in May that marketplace enrollment declined during the 2026 open enrollment period and that more consumers shifted into lower-premium, higher-deductible plans after the enhanced subsidies ended. The organization said average deductibles increased sharply and projected further reductions in active enrollment as some consumers struggle to keep up with premium payments.
CMS Administrator Mehmet Oz said in December that enrollment in ACA health plans had fallen compared with the previous year, coinciding with the subsidy expiration. According to CMS figures cited by Reuters, average annual premiums for subsidized plans were expected to rise substantially in 2026.
Health policy experts have warned that middle-income households may be among the most affected because eligibility rules reverted to pre-pandemic standards. KFF said many consumers whose incomes exceed traditional subsidy thresholds no longer qualify for assistance, increasing the likelihood that some may drop coverage altogether.
“The enhanced premium tax credits significantly expanded Affordable Care Act marketplace affordability,” KFF said in a recent analysis examining the effects of their expiration.
Supporters of extending the subsidies argue that the additional assistance helped drive record enrollment and reduced the number of uninsured Americans. Some healthcare groups and Democratic lawmakers have called for renewed federal action to restore affordability protections.
Republican lawmakers who opposed extending the subsidies have argued that temporary federal assistance increased government spending and that longer-term reforms should focus on market-based approaches to healthcare coverage.
The issue has also affected insurers. Analysts reported that higher consumer costs and enrollment uncertainty have altered marketplace participation and plan selection patterns for 2026.
As of June, no new federal legislation restoring the expired enhanced subsidies had been enacted. Healthcare advocates, insurers and state marketplace officials continue to monitor enrollment trends as consumers face higher coverage costs during the 2026 plan year.
