Most Americans who rely on health insurance under the Affordable Care Act, known as Obamacare, will begin signing up for 2026 coverage on Saturday. But next year, premiums could be significantly higher for millions of households.
Premium tax breaks added during the pandemic have been at the center of the ongoing government shutdown and are a major driver of expected price increases next year.
More than 24 million people are currently covered by the ACA, a law passed 15 years ago to expand access to affordable health care. Analysts warn that average premiums could rise by as much as 26%with some families facing sharper increases as federal subsidies expire and market premiums rise.
Here's what you need to know about what's driving potential raises.
What is the Affordable Care Act?
The Affordable Care Act, passed in March 2010 under the Obama administration, provides subsidized health insurance to Americans earning between 100% and 400% of the federal poverty level. These subsidies…known as premium tax credits— designed to reduce the cost of monthly insurance premiums for low- and middle-income households.
The poverty threshold varies depending on family size, ranging from $15,650 for an individual to $54,150 for a family of eight. in 2025. Families earning less than 138% of the poverty level are also eligible for expanded Medicaid coverage, although 10 statesThe US, including Texas, Florida and Georgia, did not accept the expansion.
What's causing health insurance costs to rise under the ACA?
Several factors are expected to cause ACA premiums to increase in 2026, but the most important is the expiration of the expanded premium tax credit at the end of 2025.
These subsidies, expanded during the pandemic and then extended by Congress, have lowered costs for millions of participants. But with negotiations over the ongoing government shutdown stalled, lawmakers have yet to agree on an extension. Democrats say Republicans' refusal to extend the loans will lead to a surge in income for working families, while Republicans argue the program leads to waste and fraud.
“Health care costs are about to skyrocket. But Republicans spent the entire quarantine with their heads in the sand,” said the Democratic leader in the Senate. Chuck Schumer on Thursday.
Without congressional action, premiums could more than double, increasing by an average of 114%, according to Congress. Kaiser Family Foundation (KFF). According to the group's estimates, 22 million of the 24 million Americans currently enrolled in ACA plans will be affected.
Read more: Rising Health Care Costs Is the Real Reason for the Government Shutdown
Who will suffer the most?
If the subsidies end, middle-income families who no longer qualify for tax breaks would face the sharpest increase in costs.
KFF forecasts show that next year for a Virginia family the deductible will rise from $800 to $20,000. In Idaho, some families may pay an additional $100 per month, while a family in Maryland may pay $500 more in premiums per month.
For legal immigrants, premium subsidies will also end in 2026. Legal residents who are ineligible for Medicaid because of their immigration status and whose income falls below 100% of the poverty level will no longer receive ACA tax benefits.
Republicans say current ACA provisions are too generous. Speaker of the House Mike Johnson argued that their content amounts to offering “free health care to illegal immigrants.”
Vice President J.D. Vance also said the tax breaks encourage waste and fraud. “Tax breaks are rightfully given to some people, and we think the tax breaks are actually fueling waste and fraud in the insurance industry. So we want to make sure the tax breaks go to the people who need them.” Vance told CBS. in an interview on October 12.
The One Big Beautiful Bill, introduced by President Donald Trump and passed in July of this year, also contributed to significant changes those eligible for the ACA, making it much more difficult for some people to enroll. According to changes in the law, which will be in force until 2034, KFF estimates that by 2034, up to 1.7 million Americans will no longer be eligible for such coverage.
How is the Trump administration changing the ACA?
President Donald Trump's One Big Beautiful Bill, passed in July, includes provisions that will change eligibility for ACA subsidies over the next decade. The administration says the reforms are aimed at cutting costs and eliminating abuses, but KFF estimates that up to 1.7 million Americans could lose ACA coverage by 2034 under the new rules.
When will Americans be able to enroll?
ACA Registration in most states opens November 1st. People have until Dec. 15 to enroll or change plans so coverage begins Jan. 1. Meanwhile, Jan. 15 is the last day to sign up for or change health insurance plans on the marketplace this year. After that date, people will be able to enroll or change plans “only if they are eligible for the special enrollment period.”
You can check registration deadlines for your state and get more information at healthcare.gov website.
