Congressional Stalemate Threatens Key Health Insurance Subsidies
Open enrollment for health insurance under the Affordable Care Act (ACA) begins November 1 in most states, but millions of Americans may face an unexpected financial shock. The enhanced federal subsidies that have kept premiums affordable for years are set to expire at the end of 2025, and Congress remains deadlocked over whether to extend them. Without action, average premiums could more than double in 2026, according to new data from KFF.
“Consumers are going to get huge sticker shock, because prices are going up,” warned Carolyn McClanahan, a physician and certified financial planner in Jacksonville, Florida. The potential lapse in subsidies could lead to a rise in uninsured Americans, higher out-of-pocket costs, and additional strain on household budgets already under pressure from inflation.
Subsidies Caught in Shutdown Gridlock
Roughly 22 million of the 24 million Americans who purchase health insurance through ACA marketplaces currently benefit from enhanced subsidies introduced under the Biden administration in 2021. Those subsidies, also known as enhanced premium tax credits, were extended once in 2022 but are scheduled to end December 31, 2025. The issue has now become central to the ongoing government shutdown — the second-longest in U.S. history.
Democrats are pushing to include the subsidies in a deal to reopen the government, while Republicans want to negotiate them separately. The outcome has major political implications: KFF reports that 57% of ACA enrollees live in Republican congressional districts, and more than 80% of all premium tax credits go to residents in states won by Donald Trump in the last election.
Premiums Could Soar in 2026
If Congress fails to extend the subsidies, ACA enrollees would see premiums rise by an average of 114% in 2026. Certain groups could be hit even harder. A 60-year-old couple earning $85,000 annually would see premiums jump by over $22,000 a year, while a single 45-year-old making $20,000 could see costs go from $0 to $420 per year, according to KFF.
Experts warn that such increases could discourage enrollment, particularly among younger and healthier individuals — a shift that would leave insurers covering an older, higher-risk pool, ultimately driving premiums even higher in future years.
Possible Ripple Effects on the Job Market
Higher costs could also reshape labor patterns. Many self-employed workers and gig economy participants may opt for traditional jobs that provide employer-sponsored insurance, while others could drop coverage entirely. “If young, healthy people don’t enroll, insurers would be left with a less healthy population of enrollees,” said Cynthia Cox, director of the ACA program at KFF. “That would likely lead to rising premiums for everyone else.”
What Consumers Should Do Now
Experts advise ACA participants not to assume Congress will act before the deadline. Prospective enrollees should base their 2026 plan selections on current prices and update their choices later if a deal is reached. “If it were me, I’d make a note to check again over Thanksgiving or in early December,” Cox said, referring to the December 15 deadline for coverage starting January 1.
Consumers can change their selections anytime during open enrollment, and those who take no action will be automatically reenrolled in their existing plan or a similar one. Financial planners suggest that even healthy individuals maintain at least high-deductible coverage to protect against unexpected medical emergencies.
Looking Ahead
If the enhanced subsidies lapse, experts fear that enrollment losses could persist even if they are later reinstated. “People will log on Nov. 1 and say, ‘I can’t afford that premium,’ and they won’t come back,” warned Jonathan Burks, executive vice president of health and economic policy at the Bipartisan Policy Center. The resulting decline in coverage could exacerbate financial insecurity and widen health disparities nationwide.
Until Congress acts, the future of affordable health insurance for millions of Americans remains uncertain — and the clock is ticking as open enrollment begins.