Unless Congress acts, Affordable Care Act (ACA) Marketplace premiums could surge to their highest levels in years. Monthly out-of-pocket expenses for subsidized enrollees are projected to rise by around 75 percent in 2026, on top of base premium increases proposed by insurers.
The spike stems from the expiration of pandemic-era enhanced premium tax credits, which were enacted in 2021 but were not renewed under this year’s budget reconciliation law. Without congressional intervention, these subsidies will disappear at the end of 2025 for over 24 million Americans insured through the ACA Marketplace.
Even if lawmakers extend the credits, premium increases are expected across the board due to rising drug costs and medical inflation, currently estimated at 8–10 percent annually. Additional factors, such as potential tariffs on medical supplies and pharmaceuticals, could push premiums up another 3 percent.
The impact extends beyond ACA enrollees. Many privately insured individuals may also see cost increases, as 51 percent of businesses plan to pass premium hikes onto employees. Analysis of 2026 rate filings by Peterson-KFF’s Health System Tracker indicates a median proposed premium increase of 18 percent, with most requests ranging from 12 to 27 percent, and over 125 insurers seeking hikes of 20 percent or more — the largest since 2018.
A June 2025 KFF poll found that 77 percent of Americans support extending the enhanced subsidies, including a majority of Republican and MAGA-leaning voters. However, the GOP remains opposed to additional spending, with some lawmakers framing the extension as an insurance company bailout, leaving the likelihood of action uncertain without a shift in political priorities.
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