Who will get hit hardest by ACA premium increases in four charts
By Alex Leeds Matthews, Tami Luhby, CNN
(CNN) — Open enrollment for 2026 coverage on the Affordable Care Act exchanges is underway. And millions of consumers are now seeing just how expensive their health insurance policies will be without the enhanced premium subsidies that have been in place since 2021.
The enhanced subsidies, which are scheduled to lapse at year’s end, have enabled many lower-income Americans to obtain coverage with no or very low monthly premiums and broadened eligibility for assistance to many middle-class consumers.
But that will all change if Congress does not agree to renew the more generous subsidies — a central sticking point in the federal spending talks to reopen the government. Those who will be hit the hardest by soaring premiums include lower-income, older and middle class enrollees.
The amount people will have to pay will more than double, on average, because of the lapsing subsidies and insurers’ rate hikes, according to KFF, a nonpartisan health policy research group.
The enhanced tax credits, which were enacted by a Democratic-led Congress during the Covid-19 pandemic in 2021 and renewed the following year, have proven very popular. They helped draw a record 24 million people to sign up for coverage in 2025.
More than 90% of enrollees are receiving premium assistance, which, for roughly half of policyholders, reduces their monthly cost to $0 or near $0.
If the enhanced subsidies lapse, about 4 million more people are expected to be uninsured in 2034, according to the Congressional Budget Office.
Much of the growth has been concentrated in Southern states, many of which have not expanded Medicaid to low-income adults. The enhanced subsidies allow the states’ residents who live just above the poverty line to receive coverage with no or very low monthly premiums.
About half of the growth since the subsidy boost went into effect comes from Texas, Florida, Georgia and North Carolina, according to KFF.
Most current enrollees live in a state won by President Donald Trump in the 2024 presidential election or in a congressional district won by a Republican lawmaker.
Democrats and Republicans on Capitol Hill remain bitterly divided over whether to extend the enhanced subsidies. The stalemate has prevented them from approving a federal funding package for the current fiscal year, leading the government to shut down on October 1. The impasse recently broke the previous record of 35 days.
Democrats say any spending bill must renew the beefed up assistance, while Republicans say they won’t negotiate until the government reopens.
Initially, the majority of Americans of all political persuasions supported extending the subsidies, according to a KFF survey conducted in late September.
But as the shutdown as worn on, support among Republicans and Make America Great Again supporters has waned.
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