Millions of Americans, already struggling with rising expenses, are confronting an expected surge in healthcare prices on the Affordable Care Act (ACA) marketplace as federal subsidies that have reduced premium costs for many enrollees are set to expire at year’s end, and Congress remains without a clear solution to address this change.
The expiration of these subsidies would have far-reaching effects. In 2025, [number] obtained insurance through the ACA marketplace, and health policy research group KFF [indicated] that 22 million of them received tax credits to lower costs.
Without the subsidies, premiums for these Americans could double—or even triple—rising by an average of 114%, according to KFF.
Some demographic groups and regions would face greater impacts than others.
Should the credits expire, premiums would increase most for older adults earning just above 400% of the federal poverty level, as they would no longer qualify for any premium tax credits. Price hikes would also vary significantly by location: [research] suggests large differences in monthly payment increases for a hypothetical 60-year-old couple earning $85,000, depending on their congressional district.
Premiums for this couple would rise most steeply in Wyoming, where they would face a 693% increase, jumping from $602 to $4,777, per the health policy group. The next largest spikes would occur in West Virginia’s first district (654% increase, from $602 to $4,540); West Virginia’s second district (599%, from $602 to $4,210); Connecticut’s fourth district (537%, from $602 to $3,833); and Illinois’ twelfth district (535%, from $602 to $3,823).
Hawaii and Alaska are unique cases due to their [specific factors], meaning 400% of the poverty level translates to a higher dollar amount in these states. In Alaska, KFF notes, premium increases would be “substantially higher.”
Meanwhile, the congressional districts in the continental U.S. with the smallest increases would all be in New York, which uses community-rated premiums—health insurance charges based on geographic area, regardless of health, age, or gender. Maryland and New Hampshire would also see smaller hikes, with enrollees over 60 earning $85,000 annually projected to experience premium increases under 200% in all congressional districts of these states. Even so, KFF states that the hypothetical older couple’s monthly payments would more than double if the subsidies expire, even in these areas.
Experts have warned that rising premiums could leave millions more Americans uninsured. This impact is also expected to be more severe in certain parts of the country. KFF [found] in another August analysis that the expiration of ACA subsidies, combined with cuts in [program], would result in 14.2 million more uninsured people nationwide, with the largest jumps in uninsured rates in California (1.7 million additional uninsured), Florida (1.5 million), Texas (1.4 million), New York (860,000), and Illinois (528,000).
[Organization], a nonprofit research group, found earlier this year that the expiration of subsidies would also broadly affect state economies, leading to reduced economic activity, job losses, and lower tax revenue. The group predicted that states that have not expanded Medicaid eligibility for adults would face the greatest economic impacts, as more residents in these states rely on the ACA marketplace for coverage.
Among these states, Texas’ economy would suffer the most dramatic losses, according to The Commonwealth Fund, with nearly 70,000 jobs lost, an estimated $410 million in state and local tax revenue lost, and almost $8.5 billion in state GDP lost.
Florida, which has [the highest percentage] of residents enrolled in an ACA marketplace plan of any state, would also take a major hit if subsidies end. The Commonwealth Fund found the Sunshine State would lose nearly 50,000 jobs, more than $300 million in tax revenue, and over $5.5 billion in state GDP.
The subsidies have been at the center of a months-long congressional battle. Democrats have long pushed to extend the tax credits beyond their year-end expiration, making an extension a key demand in the spending standoff that led to the longest [shutdown] in history this fall. A group of [lawmakers], mostly centrists, ultimately broke ranks to end the shutdown, with the condition that a vote on extending the subsidies would be held in December.
However, Republican congressional leaders have proposed health care plans that do not include extending the tax credits, and Senate Republicans last week blocked a competing Democratic proposal to extend them. With fewer than three weeks left in 2025, the expiration of the subsidies appears all but certain.