Millions of Americans will have trouble finding affordable health insurance this year. As a result, many of them will find it difficult or impossible to pay for health care for themselves and family members. Health care journalists have been writing this story for years and will continue to cover this story well into the future.
See, for example, this Jan. 22 op-ed Tracie McMillan wrote for The New York Times: “We Asked 300 People About Health Care Costs. The Numbers Are Shocking.” Or read this piece Aimee Picchi wrote about high health insurance costs for CBS News in November: “Some Americans are getting sticker shock as they shop for Affordable Care Act insurance.” While interviewing 12 New England members of Congress, three Boston Globe reporters collected multiple anecdotes about consumers confronting rising health insurance costs of health.
High costs of health insurance and health care have long been a burden for Americans, as KFF reported in December: “Americans’ Challenges with Health Care Costs.” Not only do such high costs affect decisions about insurance but also about how and when to seek care, the KFF researchers noted. Rising expenses and the potential to face unexpected medical bills rank among the top financial worries for adults and families, they added.
Multiple factors driving up costs
One big factor driving up health insurance costs is the failure of Congress to extend the enhanced advance premium tax credits (APTCs) that allowed 22.4 million Americans to enroll in subsidized health insurance plans through the Marketplaces of the Affordable Care Act (ACA), also called Obamacare. On Jan. 8, the House passed a bill granting a three-year extension of the tax credits after they expired in December. The legislation is currently under consideration in the Senate.
The second factor is that ACA insurers are raising rates as high as 15% for individuals and small-group plans, Nona Tepper reported for Modern Healthcare in July.
Health insurance rates will go up because medical costs could rise by 7% to 8% this year due to the high costs of prescription drugs and hospital and physician care, as The Commonwealth Fund explained in September. “Insurers in our sample attributed from 1 to 14 percentage points of the 2026 proposed rate increases to the expiration of enhanced premium tax credits,” the Commonwealth Fund’s researchers added.
‘Insurers are concerned’
During a Jan. 22 media briefing on health insurance and the ACA, Gerard Anderson, Ph.D., a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, explained that rising health care costs force insurers to increase rates by at least that much.
“Also, they [insurers] are very concerned that people will drop [their] coverage when the premiums go up,” he added. “They have to build that into the rates. So it’s not surprising that the rates will go up by 10% or 11%.”
“All of us in health economics are very concerned that insurance, especially in the ACA plans, will start being more and more expensive as the sick people remain and the healthy people drop,” he commented.
Elizabeth Fowler, Ph.D., a research scientist and Anderson’s colleague in the Johns Hopkins Department of Health Policy and Management, also addressed the briefing. The disruption in health insurance markets results from “historic reductions in Medicaid funding and other policies to reduce Medicaid coverage,” that Congress passed in July in the budget megabill, she said.
“The Congressional Budget Office estimated that the One Big Beautiful Bill could potentially result in up to 10 million people losing health coverage,” she added. “That bill could have included a renewal of the Covid ACA subsidies.”
In addition to eliminating the enhanced APTCs, the budget bill also cut nearly $1 trillion from Medicaid, Fowler noted. “Taken together, these cuts are only going to place more pressure on hospital costs and hospitals’ bottom lines,” she explained. “Any proposal to give back money to the people will not be able to make up for these gaps,” she added, referring to what President Trump announced on Jan. 15 as “The Great Healthcare Plan.”
As Jessica Wong reported for Yahoo Finance, “Under this plan, the federal government would stop sending advance tax credits to consumers’ insurers to reduce their premiums and instead send this money ‘directly to eligible Americans to allow them to buy the health insurance of their choice.’ … The plan is short on specifics. There’s no clear explanation of who would get the money, how much it would be, or when payments would start.”
Reduced insurance tax credits
In 2021, Congress passed the American Rescue Plan Act during Covid that included the enhanced advance premium tax credits (APTCs). Those enhanced credits were extended through the end of 2025 under the Inflation Reduction Act of 2022, helping to boost enrollment in ACA Marketplace plans for four straight years (2022 through 2025), KFF reported in April. Since 2020, enrollment in the Marketplaces has more than doubled, rising from 11.4 million in 2020 to 24.3 million last year, an increase of 113%, the KFF researchers wrote.
Louise Norris, a health policy analyst for healthinsurance.org, explained that the earlier ACA premium tax credits are still in place because the subsidy rules have reverted to the levels Congress set before 2021. That means most Marketplace enrollees can get APTCs, as was the case before 2021.
But the 2026 APTC doesn’t cover as much of enrollees’ premiums as it did last year, and consumers with household income over 400% of the federal poverty level (FPL) have lost their premium tax credits altogether. For a single-person household, 400% of FPL is $63,840 in annual income, and for a family of four, it’s $132,000.
Open enrollment has ended in all states except Virginia where enrollment ends Friday, Jan. 30, and in California, Connecticut, Illinois, New Jersey, New York, Pennsylvania, Rhode Island, and the District of Columbia where the deadline is Saturday, Jan. 31, healthinsurance.org reported.
“If you’re in a state where open enrollment is ongoing, enrolling today means coverage starts Feb. 1, except D.C., where they’re enrolling for March 1,” Norris said by email.
Individuals and families enrolling for 2026 in the same ACA plan they had last year will find their health insurance premiums would cost 114% more on average this year than they did last year, according to this report from the Peterson-KFF Health System Tracker.
Even if health insurance premiums cost much more than last year, that amount could be lower than what a family would pay if one member has a high-cost illness or needs care totalling a not-unusual hospital charge of perhaps $10,000 or $20,000, Gerard Anderson advised in the Jan. 22 media briefing.
“About 80% of people don’t get sick in any given year, but 20% of us have a major illness or major expenditures that you probably can’t afford to pay for yourself. That would be something more than $5,000 — typically $20,000 if you ended up going to the hospital, or more,” he said, adding that he would advise anyone living in states with extended deadlines to get insurance this week.
State and congressional district health plan rates
Charles Gaba, a researcher who publishes data on Obamacare enrollment at acasignups.net, has estimated insurance payments in each state and in each congressional district. Using numbers from KFF’s Subsidy Calculator, the See Plans and Prices site at healthcare.gov and state-based ACA exchange sites, Gaba calculated 2026 rates for four different households and income levels as follows:
- A 50-year-old single adult earning $20,000 to $70,000 annually,
- A 30-year-old single parent who has an 8-year old child and earns $20,000 to $90,000 each year,
- A 40-year-old couple who earn $40,000 to $130,000 annually and has two children aged 12 and 15, and
- A 64-year-old couple who earn $20,000 to $90,000 a year.
You can view the numbers and Gaba’s methodology for each state here.
“In terms of average gross price increases in ACA premiums, Florida is in the upper third nationally,” Gaba said in an interview. “On average nationally, West Virginia and Wyoming are the most expensive in terms of those buying a full-price ACA plan.”
Resources
- Setting the Record Straight on Premium Tax Credit Enhancements, Center on Budget and Policy Priorities, Jan. 12, 2026
- This health insurance alternative could leave pregnant patients footing the bill, Shefali Luthra, The 19th, Jan. 21, 2026
- Despite High Health Spending, Millions in the U.S. Struggle to Access Care, The Commonwealth Fund, Jan. 6, 2026
- Trumps Cuts Are About to Make Health Care Even Worse, Nicholas Kristof, The New York Times, Jan. 3, 2026
- Which states offer their own health insurance subsidies?, HealthInsurance.org, Jan. 5, 2026
- Calculator: ACA Enhanced Premium Tax Credit, KFF, Oct. 26, 2026
- Ask an Expert: Enhanced Premium Tax Credit (PTC) Expiration, Center on Budget and Policy Priorities, Oct. 22, 2025
- Enhanced Premium Tax Credits: Who Benefits, How Much, and What Happens Next?, Bipartisan Policy Center, Oct. 15, 2025
- Enhanced Premium Tax Credits for ACA Health Plans: Who They Help, and Who Gets Hurt If They’re Not Extended, The Commonwealth Fund, Feb. 18, 2025
- “Unforeseen Health Care Bills and Coverage Denials by Health Insurers in the U.S.,” the Commonwealth Fund, Aug. 1, 2024
- How the American Rescue Plan Will Improve Affordability of Private Health Coverage, KFF, March 17, 2021
