Expiration of ACA subsidies could double premiums for many

Late Wednesday night, President Donald Trump signed a funding bill to reopen the federal government after the longest shutdown in U.S. history.

The shutdown largely centered on whether to extend Premium Tax Credits, or PTCs, for the Affordable Care Act, which are set to expire in 2026. Their expiration would result in significant premium increases for people who buy insurance through the ACA marketplace.

Democrats had refused to approve a funding bill without assurances from Republicans that the tax credits would be extended. The deal agreed to by Senate Republicans and a handful of Democrats last Sunday only guarantees a December vote on the tax credits.

Even if the Senate approves renewing the subsidies, House Speaker Mike Johnson, R-La, hasn’t agreed to a matching House vote on the issue, making the chances of an extension increasingly bleak.

According to the Kaiser Family Foundation, enrollees with incomes above 400% of the federal poverty level would face steep increases in premium payments if the enhanced tax credits expire. A 60-year-old couple earning $85,000 a year could see annual premiums rise by more than $22,600 in 2026. Many subsidized enrollees are expected to see their premiums double between 2025 and 2026.

The Affordable Care Act, also known as “Obamacare,” was enacted in 2010 to expand health insurance coverage and reform the insurance market. Premium tax credits have been part of the law since its passage, but they were expanded in 2021 under the American Rescue Plan Act. They were originally set to expire in 2023 but were extended through 2025 by the Inflation Reduction Act.

Ninety-three percent of marketplace enrollees—more than 20 million people—receive premium tax credits, according to the Center on Budget and Policy Priorities. The expanded credits allow individuals with incomes roughly between $16,000 and $23,000 to pay no monthly premiums.

“When people don’t have insurance, we’re still going to take care of them,” North Shore Health CEO Kimber Wraaldstad told WTIP, “and that becomes more of a challenge for us, for bad debt and other types of things. ”

Rising marketplace premiums could lead some people to drop their coverage. Hospitals often absorb the cost when uninsured patients seek emergency care, generating unrecoverable “bad debt.” Uninsured individuals also tend to delay treatment, which can result in more serious and expensive health issues.

“People are less likely to go and seek the care that they need if they don’t have insurance,” Wraalstad said.  “You’re going to let something get so so bad. It’s going to cost more on the back end.”

The impact can compound as more people lose coverage, delay care, and require urgent treatment.

Cook County is home to many artists, contractors, seasonal workers, and self-employed residents who may rely on the ACA marketplace. Tourists visiting the county also use local clinics and the hospital, making it difficult to gauge the number of patients impacted.

But the effects of ACA subsidies extend beyond those who use the marketplace. Insurance companies could see their risk pool grow as healthy Americans choose to go without health insurance, leading to continued price increases.

“A lot of people are facing higher deductibles for their insurance coming up. We are just looking at how we can continue to focus on our mission,” Sawtooth Mountain Clinic CEO Kate Surbaugh told WTIP, “that we offer primary and preventative health care for anyone, regardless of the ability to pay.”

Surbaugh said the clinic is preparing to support patients who may lose access to affordable insurance if the tax credits sunset.

If the enhanced premium tax credits expire, lawmakers could still find other pathways to help Americans afford health insurance – though reaching any deal will likely be difficult in a divided Congress, particularly on an issue that has long been polarizing.

Trump on Saturday called for sending the money saved by not extending the subsidies “directly to the people.” On his Truth Social platform, he criticized the Affordable Care Act and said Americans should be able to use the savings to purchase other kinds of care instead.

The plans are for now initial and far from being set in motion, and it’s unclear how much money they could save Americans on health care.

The Associated Press contributed to this article.

Josh Hinke November 15, 2025