Premium payments will more than double in 2026 if enhanced premium tax credits are allowed to expire at the end of this year as scheduled, a KFF analysis found.
“There is a hot debate in Washington about the looming ACA premium hikes, but our poll shows that most people in the Marketplaces don’t know about them yet and are in for a shock when they learn about them in November,” said Drew Altman, president and CEO of KFF.
Extension of the tax credits has been a major point of contention during the ongoing federal government shutdown. Much of the debate centers on balancing greater coverage with substantially higher costs. If the credits are not extended, about four million additional Americans will uninsured by 2034, the Congressional Budget Office estimates. However, extending the credits would increase the federal debt by $350 billion during the same period.
House Speaker Mike Johnson, R-La., said the issue could be addressed after the government reopens and before the credits expire. “We have effectively three months to negotiate,” he told MSNBC on Monday. “In the White House and in the halls of Congress, that’s like an eternity.”
However, Democrats want to renew the credits as soon as possible, before Americans see their premiums spike and have to make health care decisions in November during open enrollment. “It is not a December thing. It is not a January thing. It is a now thing,” Sen. Amy Klobuchar, D-Minn., told NPR.
Since 2014, the ACA has capped how much subsidized enrollees pay for their health insurance premiums at a certain percentage of their income, with the federal government covering the remainder in the form of a tax credit. Enhanced tax credits work by further lowering the share that ACA Marketplace enrollees pay for a plan. KFF cited an example of how the expiration of the enhanced credits would affect an enrollee:
- With the enhanced tax credits in place, an individual earning $28,000 will pay no more than around 1% ($325) of their annual income toward a benchmark plan.
- If the enhanced tax credits expire, this same individual would pay nearly 6% of their income ($1,562 annually) toward a benchmark plan in 2026. This individual would experience an increase of $1,238 in their annual premium payments.
A previous KFF analysis, based on data released by the federal government, showed that the enhanced premium tax credits saved subsidized enrollees an average of $705 annually in 2024, bringing their annual premium payment down to $888. Without the enhanced credits, annual premium payments in 2024 would have averaged $1,593 (more than 7% higher than the actual $888).
Enrollment in the ACA Marketplace has more than doubled to 24 million since the enhanced credits were introduced. If the credits expire, many Marketplace enrollees will continue to qualify for a smaller tax credit, while others will lose eligibility altogether and also have to pay higher premiums.
“Based on the earlier federal data and more recent other publicly available information, KFF now estimates that, if Congress extends enhanced premium tax credits, subsidized enrollees would save $1,016 in premium payments over the year in 2026 on average,” the KFF report said. “In other words, expiration of the enhanced premium tax credits is estimated to more than double what subsidized enrollees currently pay annually for premiums — a 114% increase from an average of $888 in 2025 to $1,904 in 2026.”
Nearly 8 in 10 Americans want Congress to extend the credits, a recent KFF health tracking poll found. Most Republicans (59%) favor an extension, along with majorities of Democrats (92%) and independents (82%) and 84% of people who buy their own health insurance, most of whom purchase through the Marketplace.
The poll also found that 7 in 10 respondents who purchase their own insurance say they would not be able to afford doubled premiums without significantly disrupting their household finances. About 4 in 10 Marketplace enrollees say they would go without health insurance coverage if the amount they had to pay for health insurance each month nearly doubled. Similar shares (37%) say they would continue to pay for their current health insurance, while 22% say they would get insurance from another source, such as an employer or a spouse’s employer.