ACA Premium Increases: Who Suffers Most? (Infographic Analysis)
Open enrollment for health coverage under the Affordable Care Act (ACA) for 2026 is currently in progress. Millions are now facing significantly higher health insurance costs as enhanced premium subsidies, in place since 2021, are set to expire at the end of the year. These subsidies have allowed numerous lower-income individuals to access coverage with little to no monthly premiums. They have also expanded eligibility for assistance among many middle-class families.
Impact of Subsidy Expiration
The expiration of these enhanced subsidies is a critical issue in ongoing federal spending negotiations. Without a new agreement, those most affected by rising premiums will include lower-income, older, and middle-class enrollees. According to the Kaiser Family Foundation (KFF), policyholders could see their monthly costs more than double on average as a result of the subsidy lapse coupled with insurers’ rate hikes.
- Enhanced subsidies have drawn a record 24 million enrollees for 2025.
- More than 90% of those enrolled benefit from premium assistance.
- About half of policyholders pay $0 or close to $0 monthly.
Projected Increases in Uninsured Rates
If the subsidies are not renewed, approximately 4 million additional Americans may lack health insurance by 2034, as estimated by the Congressional Budget Office. Much of this surge is projected to happen in Southern states, where Medicaid has not been expanded for low-income adults. The increased subsidies previously enabled residents just above the poverty line to afford affordable coverage.
Geographical Trends in Enrollment
Sizable enrollment growth since the subsidy enhancements took effect is mainly observed in states like Texas, Florida, Georgia, and North Carolina. Notably, many current enrollees reside in states or districts that supported President Donald Trump in the 2024 election.
Political Stalemate
Disagreement over extending the enhanced subsidies has led to a legislative deadlock in Congress. This impasse has stalled the approval of a federal funding package for the current fiscal year, which resulted in a government shutdown on October 1—breaking a previous record of 35 days.
- Democrats demand subsidy renewal in any spending bill.
- Republicans refuse negotiations until government operations resume.
Initially, a majority of Americans favored extending the subsidies, as indicated by a KFF survey from late September. However, support among Republicans and Make America Great Again supporters has diminished as the shutdown continues.
As the deadline approaches for subsidy expiration, the stakes remain high for millions of Americans relying on affordable healthcare options under the ACA.
