Obamacare Premiums Set to Surge in 2026 Amid Expiring Subsidies and Rising Medical Costs

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A Perfect Storm for ACA Enrollees: Higher Costs, Lower Support

Millions of Americans enrolled in Affordable Care Act (ACA) plans are bracing for a tough year ahead. In 2026, double-digit premium increases and the expiration of expanded federal tax subsidies are expected to hit consumers simultaneously — a blow that could cause significant drops in enrollment and coverage loss across the U.S.

Insurers Push for Double-Digit Rate Hikes

Health insurers in 19 states and the District of Columbia have requested a median 15% premium increase for 2026 — more than double the proposed rate for 2025. These increases account for:

Rising medical costs, including inflation and expanded use of expensive drugs like weight-loss medications.
Labor cost increases in the healthcare sector.
Policy uncertainties created by President Trump’s recently signed “One Big Beautiful Bill.”
Tariff-driven drug price inflation, potentially adding another 3% to premiums.

Key Policy Shifts Driving Cost Uncertainty

One of the most significant financial threats to ACA enrollees is the potential expiration of enhanced tax subsidies first introduced under President Biden’s American Rescue Plan in 2021 and extended by the Inflation Reduction Act through 2025. If Congress allows them to lapse:

Most ACA policyholders will pay much higher premiums out of pocket.
Households earning above 400% of the federal poverty level (e.g., $128,600 for a family of four) will lose all subsidy eligibility.
Average premium contributions could rise by over 75%, with some states seeing doubling of premiums.

Insurers Add Extra Charges Anticipating Subsidy Expiration

Insurers are building an average 4% rate increase into their proposals just to buffer against enrollment losses expected if subsidies vanish. With a smaller insured population — likely sicker and costlier — insurers expect their overall risk profile to worsen, pushing rates even higher in future cycles.

Massive Drop in ACA Enrollment Projected

According to the Wakely Consulting Group, ACA enrollment could plunge by up to 57% due to:

The end of enhanced subsidies.
New administrative burdens from the Trump administration’s healthcare reforms.
Rising premiums and affordability challenges.

Regional Variations Reveal the Scope

In Maryland, insurers are asking for 8.1% to 18.7% increases, averaging around 7.9% if subsidies are extended — but jumping to 17.1% if they are not.
New York shows even wider variability, with proposed rate changes ranging from under 1% to a staggering 66%.

These filings underscore the uncertainty that different insurers are facing as they prepare for 2026.

Policy Debates Continue in Congress

Lawmakers are weighing various solutions:

Some propose middle-ground options — like extending partial subsidies to households earning up to five or six times the poverty level.
Others advocate for new savings tools, such as Health Savings Accounts (HSAs) for people in low-premium plans (e.g., Bronze or Catastrophic tiers), introduced under Trump’s latest law.

However, political opposition and concerns over subsidy misuse could delay or derail these discussions.

Political and Market Impacts

56% of ACA enrollees live in Republican congressional districts, and 76% are in states carried by Trump in the last election — making the subsidy debate politically risky.
A sudden increase in premiums without subsidy extensions could lead many to downgrade to high-deductible plans, exit the marketplace, or remain uninsured.

Conclusion: 2026 Will Be a Pivotal Year for the ACA

With rising premiums, potential subsidy rollbacks, and increasing policy complexity, 2026 could mark a critical turning point for the Affordable Care Act. Whether Congress acts or not, millions of Americans — and the insurers who cover them — will feel the effects of these compounded financial pressures.

Stay tuned as final premium rates and subsidy decisions unfold closer to the November 1 open enrollment date.