ACA health coverage subsidy lapse hit 22 million people; some effects

Enhanced subsidies that helped millions of people afford health insurance on the Affordable Care Act marketplace expired at the end of 2025 — which has forced many people to make tough financial choices.

The enhanced subsidies, which had been in place since 2021, reduced insurance premiums for about 22 million people last year, or more than 90% of all ACA enrollees.

KFF, a nonpartisan health policy research group, estimates the lapse caused premiums to more than double for the average recipient in 2026.

The impact will likely extend far beyond households’ wallets: Political pundits have said the financial fallout could sway the outcome of the midterm elections in November.

Democrats in Congress have pushed to extend the enhanced subsidies. Most Republicans in Congress have so far said they’re opposed, even though health policy experts said the enhanced subsidies caused ACA enrollment to surge in red states. As of last year, 88% of enrollment growth in the ACA marketplace since 2020 — or 11.4 million out of 12.9 million new enrollees — occurred in states President Donald Trump won during the 2024 election, according to KFF.

In an emailed statement, White House spokesman Kush Desai said the number of consumers affected by the expiration of the enhanced premium subsidy was a relatively small share of the U.S. population.

“Instead of merely throwing more money at insurance companies as Democrats are clamoring for, President Trump is focused on delivering meaningful affordability for every American with his Great Healthcare Plan,” he said.

Policy experts describe the ACA marketplace as a last resort for people who can’t get insurance through other means, such as employer-sponsored coverage, or through Medicare or Medicaid, the federal health programs for seniors and lower earners, respectively.

About 7% of the total U.S. population gets health insurance via the ACA marketplace, according to the Pew Research Center.

Small business owners, gig workers, freelancers and early retirees are examples of those who turn to the ACA marketplace for insurance.

Now, many of those Americans must decide whether to pay higher premiums, downgrade their coverage or perhaps drop their health insurance altogether.

Here are three of their stories, which CNBC verified by reviewing documents including health insurance and tax records.

Nancy Linder, 47, said she needs health insurance — and the ACA marketplace is currently the only good option for her and her husband.

However, health premiums for the couple, who live outside Atlanta, tripled in 2026.

They now pay $483 per month for their insurance plan, up from $162 per month in 2025 — a difference of nearly $3,900 per year.

That’s a substantial increase relative to their income of about $30,000, according to the most recent tax records.

“When we found out the [enhanced] subsidies were going away, I freaked out,” Nancy said. “Because in my mind, they were necessary for us to be able to afford the marketplace insurance.”

The Linders have purchased health insurance on the ACA marketplace since 2019.

That year, Linder’s husband lost his corporate job, which was outsourced overseas, and he started a business reselling items acquired at estate sales, auctions and other outlets, she said.

Linder, a former teacher, doesn’t work anymore due to a host of medical issues — including treatment for a brain tumor and its effects, and Parkinsonism, a neurological disorder that causes Parkinson’s-like symptoms.

She sees a roster of doctors — a neuro-oncologist, epileptologist and movement disorder neurologist, among others — during the year and takes numerous medications, she said.

“I have to have health insurance,” she said.

The Linders have been on the same silver-tier health plan since first signing up for ACA coverage.

It’s one of the few coverage options available in the area that all of her doctors accept, Linder said. It has an out-of-pocket maximum of $1,500 for 2026, which she says is relatively affordable for them.

“I’m expensive,” she said. “I had to make sure we had a really good health insurance plan.”

The federal government is still paying a baseline level of ACA subsidies, known as premium tax credits, even after the enhanced subsidies lapsed.

However, the subsidies are less generous and funding is available to fewer households.

Households that qualify for subsidies can opt to receive them in a lump sum during tax season, or in advance as a direct reduction of their monthly premiums.

Most people — including the Linders — choose to get the subsidies in advance. The government pays the advance tax credit based on an estimate of annual income that enrollees provide during sign-up, and reconciles any overpayments or underpayments during tax season.

Nancy and her husband estimated the same annual income for 2025 and 2026. That’s an important detail because it shows that their insurance premiums haven’t fluctuated due to changes in that estimate.

The extra $321 a month the couple now puts toward health premiums will force them to live a leaner lifestyle, Nancy said.

They typically dine out once a week, but now choose fast food rather than a sit-down meal, she said. It’s likely they will soon need to replace their car and truck, but a reduced cash flow makes it harder to save for such things, she said.

They didn’t take a vacation in 2025, to prepare financially in the event enhanced ACA subsidies were to expire, she said. They also won’t take one this year.

“I miss vacations,” Nancy said.

Kate Bivona and her husband chose to downgrade their health insurance rather than pay sharply higher premiums.

The couple, musicians from Arizona, would have paid nearly $400 per month in out-of-pocket premiums this year if they kept their health plan — more than triple the $118 a month they paid in 2025.

“We just don’t have that kind of cash,” said Bivona, 37, a violinist and violin teacher. “We get by, but we weren’t suddenly ready for a large increase like that.”

They chose to enroll in a bronze-tier plan and ditch their silver-tier coverage.

Bronze plans generally come with a trade-off compared with other levels of ACA marketplace insurance: lower premiums on the front end, but higher out-of-pocket costs on the back end if a consumer needs medical care.

For example, the average bronze plan has a nearly $7,500 annual deductible in 2026, according to KFF. The average across all ACA marketplace plans is $2,900, it found.

A deductible is the amount households pay toward in-network medical costs before the insurance starts paying for care.

Bivona and her husband pay $158 per month in premiums in 2026, slightly more than in 2025. However, their annual deductible for medical care is $15,000 — up sharply from last year, when the couple had a $0 deductible for medical care and $1,500 for prescriptions.

It “skyrocketed,” she said.

Bivona and her husband are relatively healthy and have their insurance mostly for “just in case” situations, she said. It would be hard for them to recover from a big medical bill, she said. They have a joint income of about $50,000 a year.

“If we have to go to the hospital or something, we’d be taking on debt for years to pay that off,” she said.

Early state-level data — in California and Pennsylvania, for example — suggests thousands of households have also chosen to downgrade to bronze plans, researchers at the Urban Institute, a left-leaning think tank, said in an e-mail.

In Pennsylvania, for example, around 33,000 more residents enrolled in bronze plans in 2026 compared with 2025, a 30% increase, according to the state’s health insurance marketplace.

In California, more than 564,000 people, or 29% of the state’s ACA enrollees, signed up for bronze plans in 2026, up from 23% of enrollees in 2025, according to state marketplace data. Meanwhile, the share of people who signed up for silver plans declined to 61% from 67% of enrollees.

Bivona said she feels it’s hard to get ahead as costs compound, including higher day-to-day expenses and about $37,000 of student debt. She tries to stash away savings, but money is tight, she said.

“It feels like we’re getting squeezed in all these different directions,” she said. “Groceries are more expensive; gas is more expensive; I’m paying interest on my student loans again. All these different things compound.”

“When you’re making a certain amount, you can’t get ahead ever,” she said. “There is a constant feeling of instability.”

Bivona said she loves her work and can’t imagine doing anything else. Even so, she and her husband have talked about trying to change jobs to get employer-sponsored insurance.

But the job market is a “total nightmare right now, so it almost even feels like that’s a risk, too, financially,” she said.

Robin Wright-Pierce and her husband decided to drop their health insurance coverage for 2026. The couple, who are self-employed, had been enrolled in an ACA marketplace plan since 2023.

Their choice was largely due to higher premiums, said Wright-Pierce, 36, who lives in Cincinnati.

“I’m currently not enrolled because of how expensive it was this year,” said Wright-Pierce, the founder and CEO of Transforming Change, a consulting firm that works with individuals and organizations to advance social justice. Her husband also works for the two-person business as its chief political strategist.

“Dropping our health insurance was a significant decision for us,” she said. “It was not something we took lightly.”

The health plan also covered their 13-year-old son. They kept ACA marketplace coverage for him.

Wright-Pierce is just one out of millions of people who are expected to drop their insurance coverage for 2026 due to higher premiums.

Early data from the Centers for Medicare & Medicaid Services suggests at least 1.5 million people dropped out of the ACA marketplace in 2026, after years of enrollment growth. The Urban Institute estimates the final tally will approach 5 million people who drop ACA coverage and go uninsured.

Enhanced subsidies allowed Wright-Pierce and her husband to qualify for a modest premium tax credit, she said.

Last year, the couple paid about $746 per month for their bronze insurance plan, or nearly $9,000 per year. That’s after accounting for a premium tax credit of $179 a month.

Enhanced ACA subsidies “made it possible for us to have health insurance that otherwise we couldn’t have afforded,” Wright-Pierce said.

However, they didn’t qualify for a premium tax credit in 2026 due to the re-emergence of the so-called “subsidy cliff.”

The policy limits eligibility for premium tax credits to households that earn less than 400% of the federal poverty line. Exceeding that threshold, or cliff, by even $1 disqualifies families such as Wright-Pierce’s from any premium assistance.

The cliff had been in place since 2014, in the early days of the ACA, but disappeared when Congress expanded the pool of enrollees eligible for premium tax credits in 2021. It came back when the enhanced subsidies expired.

The cliff threshold varies depending on household size. For example, a family of three with an income over $106,600 is ineligible for subsidies this year.

Wright-Pierce’s household income exceeded this threshold in 2025, and she said she expects the same for this year — disqualifying them from a premium tax credit.

Their premium would have increased to about $1,000 a month out of pocket for the same health plan, she said — adding roughly $3,000 to their annual insurance premiums.

“There should never be a point in time where the cost of being able to go see a doctor rivals your rent, your mortgage,” Wright-Pierce said.

There were other considerations, too: For example, the couple’s insurance plan didn’t offer access to a large roster of physicians, Wright-Pierce said. Enrolling in a plan with a broader pool of in-network doctors, something the couple had been considering, would have cost between $1,600 and $2,000 per month, she said.

They still pay $231 per month for their son’s ACA coverage.

Wright-Pierce and her husband are healthy and don’t frequently visit the doctor, she said.

They plan to save the amount paid in premiums last year and set it aside each month in case medical issues arise, Wright-Pierce said.

“The amount of juggling we have to do to just have insurance is not rational,” she said. “More is possible for our country.”