Millions of Americans, already battling rising health insurance costs, are staring down the barrel of an anticipated surge in prices for healthcare on the Affordable Care Act (ACA) marketplace as federal subsidies that have lowered premium payments for many enrollees are set to expire at the end of the year, and Congress still has no clear solution in sight to address the change.
The impact of the subsidies expiring would be widespread. In 2025, 24 million individuals obtained insurance through the ACA marketplace, and health policy research group KFF estimates that 22 million of them received tax credits that help reduce costs.
Without the subsidies, premiums could double—or even triple—for those Americans, increasing by an average of 114%, according to KFF.
Read More: What the End of Obamacare Subsidies Could Mean for Your Health Coverage
Some demographics and areas would be hit harder than others.
If the credits expire, premiums would increase most for older adults making just over 400% of the federal poverty level, as they would no longer qualify for any premium tax credits. The price hikes would also vary significantly based on where enrollees live: KFF found in October that there would be large differences in the increases in monthly payments for a hypothetical 60-year-old couple making $85,000 based on which congressional district they live in.
Their premiums would rise most sharply in Wyoming, where they would be subject to a 693% increase, climbing from $602 to $4,777, according to the health policy group. The next biggest increases would hit in West Virginia’s first district, where the couple’s monthly premiums would spike by 654% (from $602 to $4,540); West Virginia’s second district, at 599% (from $602 to $4,210); Connecticut’s fourth district, at 537% (from $602 to $3,833); and Illinois’ twelfth district, at 535% ($602 to $3,823).
Hawaii and Alaska are unique cases due to their differing poverty level guidelines, meaning that 400% of the poverty level is a higher dollar amount in those two states. In Alaska, according to KFF, premium increases would be “substantially higher.”
Meanwhile, the congressional districts that would see the smallest increases in the continental U.S. are all in New York, which uses community-rated premiums, meaning that health insurance charges are based on geographic area regardless of health, age, or gender. Maryland and New Hampshire, also would see smaller increases, with enrollees over age 60 making $85,000 annually expected to see premium increases under 200% in all congressional districts in those states. But even in those areas, the hypothetical older couple’s monthly payments would more than double if the premiums expire, according to KFF.
Experts have warned that the rising premiums would leave millions more Americans uninsured. That impact is also expected to hit some parts of the country harder than others. KFF found in another analysis in August that the expiration of ACA subsidies coupled with cuts in President Trump’s Big Beautiful Bill would result in 14.2 million more people becoming uninsured across the country, with the uninsured population increasing most significantly in California, with an estimated 1.7 million additional uninsured; Florida, with 1.5 million; Texas, with 1.4 million; New York, with 860,000; and Illinois, with 528,000.
The Commonwealth Fund, a nonprofit research group, found earlier this year that the subsidies expiring would also affect states’ economies more broadly, leading to declining economic activity, job losses, and lower tax revenue. The group predicted that states that have not expanded Medicaid eligibility for adults would suffer the greatest economic impacts, as more residents in those states rely on the ACA marketplace for coverage.
Texas’ economy would see the most dramatic losses among that group, according to The Commonwealth Fund, losing almost 70,000 jobs, an estimated $410 million in state and local tax revenue, and almost $8.5 billion in state GDP.
Florida, which has the highest number of residents enrolled in an ACA marketplace plan of any state, would also be take a major hit if the subsidies end. The Commonwealth Fund found the Sunshine State would lose almost 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 battle in Congress. Democrats have long been pushing to continue the tax credits past their current expiration date at the end of the year, making an extension a key demand in the spending standoff that led to the longest government shutdown in history this fall. A group of eight Democratic senators, most of them centrists, ultimately broke ranks to end the shutdown on the condition that a vote would be held on extending the subsidies in December.
But Republican leaders in Congress have put forward health care plans that do not include an extension of the tax credits, and Senate Republicans last week blocked a competing proposal from Democrats in the chamber that would have extended them. With less than three weeks left before 2025 comes to a close, the expiration of the subsidies seems all but guaranteed.
