Average ACA Premium Payments for Subsidized Enrollees Rose 114% in 2026 After Enhanced Tax Credits Expired
Enhanced federal subsidies lapsed on December 31, 2025; federal data show marketplace enrollment was down about 12% by February 2026, and insurers have proposed a median premium increase of about 15% for 2027.
The Number Everyone Quotes Is Measuring the Wrong Thing
A subsidized Affordable Care Act enrollee who kept their coverage this year is paying about $1,016 more a year than they did in 2025. That's the number behind the widely repeated claim that premium payments rose 114%, from roughly $888 to roughly $1,904 a year, according to KFF[1]. It's the single most-quoted figure in this story, and it's also the one most likely to mislead a reader who doesn't stop to ask what it actually covers.
That 114% is not the price of the insurance plan. It's what the enrollee pays out of pocket after subsidies. The sticker price of ACA marketplace plans — what insurers actually charge — rose by a median of about 20% for 2026, the largest jump since 2018[19]. A subsidy shrinking can double a household's bill even when the plan itself gets only modestly more expensive. Both sides in this fight use the 114% figure anyway, just for opposite reasons: one to show real hardship, the other to argue the old subsidy was unusually generous in the first place.
The cause is not a mystery or a future event. It's a completed one. Enhanced federal tax credits that had been subsidizing ACA marketplace premiums since 2021 expired at midnight on December 31, 2025, and were not renewed[5]. About 22.4 million people — 92% of everyone on the marketplaces — had been receiving those enhanced credits in 2025[5]. Coverage news about this often still uses future tense, saying premiums are "set to rise" or enrollees "could" lose coverage. As of August 2026, that framing is eight months out of date. The increase already landed, and the federal data are already in[4].
Nearly 3 Million People Left, and No One Fully Agrees Why
The clearest data point in this story is also the most contested one. Federal enrollment figures show marketplace coverage fell from about 21.8 million people in February 2025 to about 19.2 million in February 2026 — a drop of nearly 3 million, or about 12%[4]. Enrollment fell in 49 of the 50 states and the District of Columbia[3]. The steepest drop hit one specific group: people earning 400% to 500% of the federal poverty line, who lost their subsidy entirely when the enhanced credits expired. Sign-ups in that income band fell 44%[2].
Here's the collision at the center of the story: two federal reports, produced by the same agency, get read in opposite directions. HHS's own Office of the Assistant Secretary for Planning and Evaluation, the same primary source behind the neutral 19.2 million enrollment figure, concluded in a June 2026 report that the entire 2.9 million enrollment decline was due to the removal of improperly enrolled or "phantom" enrollees, not people losing affordable coverage[4]. The same report estimated about 2.6 million such improper enrollments still remain on the rolls[4]. Democrats and outside health researchers dispute that reading of the data[4].
That's the real fight underneath the numbers. Was the enrollment drop mostly real people losing coverage they wanted and needed? Or was it mostly enrollments that shouldn't have existed falling away once subsidies got smaller? The honest answer is that no public dataset cleanly separates the two. Both things can be true at the same time, and each side has reason to claim the whole 2.9 million as evidence for its case.
Why a Subsidy That Covers 100% of a Premium Creates an Incentive Problem
To understand the fraud argument, it helps to know how the enhanced credits actually worked. For the lowest-income enrollees, the credits could cover 100% of the monthly premium, making the plan free to the person signing up. That design had a side effect: because the plan cost the enrollee nothing either way, neither the enrollee nor the broker signing them up had much reason to double-check that the stated income was accurate. Insurers, meanwhile, get paid per enrollee regardless of whether that person is legitimately eligible.
Conservative researchers argue that gap let error and outright fraud accumulate over several years. Paragon Health Institute, a conservative think tank, estimated more than 6 million people were improperly enrolled, costing taxpayers close to $25 billion[12]. House committee chairmen have cited a Government Accountability Office covert test in which government investigators submitted fictitious applications that got approved, and most of the fake enrollees kept their coverage into 2025[14]. From this vantage, letting the enhanced credits expire wasn't cutting people off from care — it was letting an inflated, poorly verified enrollment count correct itself[13].
Democrats and health-coverage advocates see the same design differently: as a fix for something called the "subsidy cliff." Before 2021, a household earning even one dollar over 400% of the poverty line lost every dollar of subsidy help at once — a hard cutoff. The enhanced credits replaced that cliff with a gradual slope, so income just above the old line didn't mean an unaffordable bill overnight. Take the slope away, they argue, and a couple just over that threshold goes back to facing the full sticker price with no transition[2]. Their strongest evidence: that 400-to-500%-of-poverty group made up just 3% of 2025 sign-ups but accounted for 27% of the entire enrollment drop[2]. The nonpartisan Congressional Budget Office has projected 2.2 million more people will be uninsured in 2026 as a result[5].
The House Voted to Extend the Credits. The Senate Hasn't.
Congress had chances to resolve this and didn't take them. In December 2025, the Senate failed to reach the 60 votes needed to advance a bill, S.3385, that would have extended the enhanced credits through 2028[9]. On January 8, 2026, the House passed a three-year extension by a vote of 230 to 196, with 17 Republicans joining every Democrat in favor[8]. The Senate has not taken up that bill. Senators from both parties reported that bipartisan compromise talks had stalled[17].
The fight wasn't just about the biggest number. Democrats forced a 43-day government shutdown over the subsidy extension, and keeping premium increases visible through the 2026 midterm elections serves them both as policy and as politics — health care traditionally polls well for their party[6]. Republicans, meanwhile, faced their own internal split. President Trump floated the idea of extending the credits and then pulled back after pushback from conservatives in his own party, and the 17 House Republicans who crossed the aisle show the issue doesn't split cleanly along party lines[6][8].
Insurers, for their part, say the political fight over subsidies is only part of what's driving costs. When subsidies shrink, healthy people are the most likely to decide coverage isn't worth the price and drop out first. The people who stay tend to be sicker, on average, which insurers call a worsening "risk pool." They have to price plans higher to cover the claims of that smaller, sicker group, which is why they cite the credits' expiration as a cost driver even though the credits were never paid directly to insurers[10]. Underlying medical costs are also just rising on their own, separate from any subsidy fight.
Insurers Have Already Filed Next Year's Rates
The 2026 increase isn't the end of the story. For 2027, insurers across all 50 states and Washington, D.C. have proposed a median premium increase of about 15% — a second straight year of double-digit hikes, following the roughly 20% median increase finalized for 2026[10]. That means the affordability fight isn't closing; it's rolling straight into the next plan year, with Congress still not having settled the underlying subsidy question.
Coverage of this story splits along familiar lines but with some notable exceptions. Protect Our Care, a Democratic-aligned advocacy group, has branded its messaging "Premium Disaster Watch" and blamed "Trump-GOP premium hikes" directly[18] — a framing that assigns a rate increase driven substantially by rising medical costs to two specific political actors. On the other side, the Wall Street Journal editorial board titled a piece "The Phantom Patients of Obamacare," a framing later circulated by the House Budget Committee, that converts a coverage-loss story into a fraud story while leaving out that the large majority of enrollees are, in fact, verified[13]. The Hill and CBS News, by contrast, largely stuck to explaining the mechanics and covering the stalled negotiations without assigning blame to either side[6][17].
What isn't in dispute: the credits are gone, have been since January 1, 2026, and around 19.2 million people held marketplace coverage in February 2026, down from 21.8 million a year before[4][5]. The subsidized enrollees who stayed are paying about $1,016 more a year on average[1]. What remains genuinely unresolved is how many of the nearly 3 million people who left were priced out of coverage they wanted, and how many were enrollments that shouldn't have existed in the first place — a question the current data can't fully answer, and one that will likely shape whatever the Senate does next.
Summary
A set of larger federal health insurance subsidies expired on December 31, 2025[5]. They were created in 2021 during the pandemic and extended by the Inflation Reduction Act. Their loss hit people who buy their own coverage through the Affordable Care Act marketplaces. The most-quoted number is 114%. That is KFF's estimate of how much the average subsidized enrollee's own share of the premium rose — from about $888 a year to about $1,904[1]. It is not how much the plans themselves went up. Insurers raised sticker prices by a median of about 20% for 2026[19].
This is not a forecast anymore. Federal data show what happened. Enrollment in the marketplaces fell from about 21.8 million people in February 2025 to about 19.2 million in February 2026 — a drop of nearly 3 million, or about 12%[4]. Enrollment fell in 49 of the 50 states and the District of Columbia[3]. The steepest fall was among people earning 400% to 500% of the federal poverty level. They lost their subsidy entirely. Their sign-ups fell 44%[2].
The two sides do not agree on what the dispute is about. Democrats and health-care advocacy groups say Congress let a working program lapse and pushed millions of people out of coverage[18]. Many Republicans say the enhanced credits were a temporary pandemic measure that inflated enrollment with people who should never have qualified. They point to a conservative think tank's finding of more than 6 million improper enrollments[12] and to a federal audit in which fake applicants got approved[14]. That is the real crux: whether the enrollment drop is people losing needed coverage, or fake and ineligible sign-ups falling off the rolls. Both things can be true at once, and the available data do not cleanly separate them.
Congress has not settled it. The Senate failed to clear a 60-vote hurdle on a bill to extend the credits through 2028[9]. The House then passed a three-year extension 230–196 in January 2026, with 17 Republicans joining Democrats[8]. The Senate has not acted on it, and bipartisan talks were reported stalled[17]. Meanwhile insurers have filed proposed rates for 2027. The median proposed increase is about 15%[10].
The Event
The Affordable Care Act's enhanced premium tax credits expired at the end of the day on December 31, 2025[5]. About 22.4 million marketplace enrollees — 92% of the total — had been receiving advance payments of those credits in 2025[5]. KFF estimated the expiration would raise the average subsidized enrollee's out-of-pocket premium payment by 114%, from about $888 to about $1,904 a year[1]. HHS reported in June 2026 that effectuated marketplace enrollment stood at about 19.2 million in February 2026, down from about 21.8 million a year earlier[4].
Undisputed Facts
- The enhanced premium tax credits were created in 2021 and extended by the Inflation Reduction Act through the end of 2025[5].
- They expired on December 31, 2025, and were not renewed[5].
- About 22.4 million enrollees, or 92% of marketplace enrollment, received advance payments of the credits in 2025[5].
- KFF estimates the average subsidized enrollee's own annual premium payment rose about 114%, from roughly $888 to roughly $1,904 — about $1,016 more a year[1].
- Separately from subsidies, insurers raised 2026 sticker premiums by a median of about 20%, the largest increase since 2018[19].
- Effectuated marketplace enrollment fell from about 21.8 million in February 2025 to about 19.2 million in February 2026, and declined in 49 of 50 states plus D.C.[3][4].
- The Senate did not reach the 60 votes needed to advance S.3385, which would have extended the credits through 2028[9].
- On January 8, 2026, the House passed a three-year extension by 230–196, with 17 Republicans voting yes; the Senate has not passed it[8].
- For 2027, insurers across all 50 states and D.C. have proposed a median premium increase of about 15%[10].
The Pressure
Strip away the moralizing and blame. What structural realities persist regardless of which narrative wins?
- The number everyone quotes measures the wrong thing
- "114%" is the change in what subsidized enrollees pay out of their own pockets, not the change in the price of insurance[1]. Sticker premiums rose by a median of about 20% for 2026[19]. A subsidy that shrinks can double a household's bill without the plan getting much more expensive. Both sides find the 114% figure useful — one to show hardship, the other to argue the old subsidy was unusually generous — so neither has a reason to explain the distinction.
- Medical costs rise regardless of who wins the argument
- Insurers propose a median 15% increase for 2027 and cite rising health service prices first among the drivers[10]. Extending the credits would change who pays, not how much the care costs. That is the part both parties' messaging leaves out.
- The enrollment drop has at least two causes and no clean split
- Federal data confirm nearly 3 million fewer enrollees[4]. Some left because the price rose. Some were never properly enrolled — a conservative estimate puts that group above 6 million[12], and a GAO covert test found fake applicants were approved[14]. No public dataset cleanly separates the two, so each side claims the whole number.
- Election timing shapes the volume
- This is a midterm year. Premium bills arrive monthly and are the most legible cost-of-living number a voter has. That guarantees the story is amplified beyond what a normal policy expiration would draw.
Material realityThe enhanced credits are gone and have been since January 1, 2026[5]. Roughly 19.2 million people held marketplace coverage in February 2026, down from about 21.8 million a year before[4]. The average subsidized enrollee who stayed pays about $1,016 more a year[1]. The House passed a three-year extension 230–196[8]; the Senate has not[9][17]. For 2027, insurers have proposed a median 15% increase[10]. None of that changes based on which framing wins. What is genuinely unresolved is how many of the nearly 3 million lost enrollees were real people who wanted coverage and could no longer afford it, versus enrollments that should not have existed.
Narrative as a weaponTwo organized campaigns are shaping this. Democratic-aligned groups such as Protect Our Care want you to read the 114% as a bill sent to working families by named politicians, and to treat every lost enrollee as a person now uninsured[18]. Conservative institutions — Paragon Health Institute, the House Budget and Judiciary Committees, and the Wall Street Journal editorial board — want you to read the same enrollment drop as fraud being flushed out, and to see the 2025 baseline as fake[12][13][14]. KFF sits in the middle and is cited by both; it is an independent health policy research group whose own briefs are more careful about the premium-payment versus premium distinction than the coverage quoting them. One last thing worth noticing: this story is often written in the future tense — premiums "set to rise," enrollees who "could" drop coverage. As of August 2026 that is eight months out of date. The increase already landed, and the federal enrollment data are already in.
How Each Side Sees It
Each major actor’s view — how it frames things, its underlying incentive, and how it’s materially affected. Tap a side to read it.
Frames it asThey argue the enhanced credits worked exactly as designed and were allowed to die for ideological reasons. Their case rests on a specific mechanism: the enhanced credits capped what a household pays as a share of its income and removed the old hard cutoff at 400% of the poverty line. Before 2021, earning one dollar over that line meant losing every dollar of help — the 'subsidy cliff.' The enhanced version replaced the cliff with a slope. Take that away, they say, and a 60-year-old couple just over the line goes from a manageable bill to an unaffordable one overnight. Their strongest evidence is that sign-ups among people at 400–500% of poverty fell 44%, and that group accounted for 27% of the total enrollment drop despite being only 3% of 2025 sign-ups[2]. They also cite CBO's projection of 2.2 million more uninsured in 2026[5]. They frame the dispute as being about whether health coverage should be affordable for middle-income people who do not get insurance at work[18].
WhyHealth care polls well for Democrats, and they forced a 43-day government shutdown over this issue[6]. Keeping premium increases visible through the 2026 midterms serves both a policy goal and an electoral one[18].
Impact on themThey lost the legislative fight in the Senate but won a House vote with 17 Republicans, which they treat as evidence the politics are moving their way[8]. Democratic-led states have tried state-level subsidies, but KFF finds that relief is limited in scope[21].
Frames it asTheir strongest argument is not that premiums do not hurt. It is that the enhanced credits were a temporary pandemic measure that was never meant to be permanent, and that extending them would lock in a large ongoing cost while masking the real problem — that the underlying price of medical care keeps rising. They point to a design flaw with a concrete mechanism: because the enhanced credits could cover 100% of the premium for the lowest-income enrollees, a broker or an enrollee had little reason to check whether the stated income was accurate, since a zero-dollar plan costs the enrollee nothing either way. Insurers, meanwhile, get paid per enrollee. Paragon Health Institute concluded more than 6 million people were improperly enrolled, at a cost near $25 billion[12]. House committee chairmen cite a GAO covert test in which fictitious applicants were approved and most kept coverage into 2025[14]. Their strongest evidence is not limited to outside groups: HHS's own ASPE report — the same federal document used elsewhere in this story for the neutral enrollment topline — concluded in June 2026 that the entire 2.9 million enrollment decline from February 2025 to February 2026 was attributable to removal of improper or phantom enrollees rather than lost affordability, while estimating about 2.6 million such enrollments still remained on the rolls[4]. Democrats and outside health researchers dispute that causal read of the same underlying data. From this vantage the enrollment drop is partly the rolls being corrected, and 'coverage losses' counted from an inflated baseline overstate the harm[13].
WhyHolding down federal spending and avoiding a permanent expansion of the ACA, a law most Republicans opposed. There is also internal party pressure: President Trump floated an extension and pulled back after conservative pushback[6].
Impact on themLetting the credits lapse avoided the cost of extension but exposed the party to blame for premium increases in an election year. Seventeen House Republicans broke ranks[8], and moderate senators pushed for a compromise that then stalled[17].
Frames it asThis group is not organized and does not speak with one voice, but its position is concrete. People who kept coverage are paying roughly $1,016 more a year on average[1]. People just above 400% of the poverty line lost help entirely and faced the full sticker price. Many chose to drop out — sign-ups in that band fell 44%[2]. Others stayed but moved to plans with higher deductibles, which means paying less each month and more when they actually get sick[2].
WhyKeeping a monthly bill they can pay while retaining protection against a catastrophic medical event. Those are in direct tension once subsidies shrink.
Impact on themNearly 3 million fewer people were enrolled in February 2026 than a year earlier[4]. Enrollment fell in 49 states and D.C.[3]. Whether a given person is 'uninsured' or was never legitimately enrolled is the contested part; the net count is not.
Frames it asInsurers say two separate forces raised 2026 rates, and blaming subsidies alone is wrong. First, medical costs rose. Second, and specific to this policy, when subsidies shrink the healthiest customers leave first — a young, healthy person is the most likely to decide the coverage is not worth the price. The people who stay are sicker on average. Insurers call this a worsening risk pool, or higher 'morbidity,' and they must price for it. That is why insurers cite the credits' expiration as a driver even though the credits were never paid to them as a subsidy for medical costs[10]. It is a claim about who remains in the pool, not about who pays the bill.
WhySetting rates high enough to cover claims without pricing so high that more healthy customers leave, which would force the same increase again the following year.
Impact on themFor 2027, insurers across all 50 states and D.C. have proposed a median increase of about 15% — a second straight year of double-digit increases, after a median finalized increase of about 20% for 2026[10].
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The Bias Ledger average rating 4.6
The same story, as framed by outlets across the spectrum, ordered least to most biased. The bias score (1 = straight, 10 = heavily spun) is an AI assessment of that framing — click an outlet to see its track record. The tell is the word choice or omission that reveals the angle.
| Outlet | Vantage | Bias | How they frame it | The tell |
|---|---|---|---|---|
| The Hill | U.S. center | 2 | "ObamaCare subsidies expire; premiums spike for millions: What to know" — explainer framing, walks through the shutdown fight and Trump's reversal without assigning fault[6]. | "Spike" is a characterization, but the piece attributes the numbers and covers both the shutdown pressure and the conservative backlash. It also separately reported the Paragon fraud claims under a headline naming the source as a "conservative think tank," which is unusually explicit labeling[12]. |
| CBS News | U.S. center-left | 2 | "Senators say bipartisan compromise on ACA tax credits has stalled" — process framing focused on negotiation failure[17]. | Low-spin, but sourced heavily to senators describing their own talks, which lets the participants set the terms of who is blocking what. |
| The Washington Times | U.S. right | 3 | "Obamacare premiums surge likely to happen in 2027, new analysis shows" — reports the 2027 rate filings straight, without the household-hardship framing[16]. | The omission is the tell in the other direction: the 2027 increase is reported as a market fact, with less emphasis on the subsidy expiration's role in worsening the risk pool that insurers themselves cite. |
| PBS News | U.S. center-left, publicly funded | 4 | "Health subsidies expire, launching millions of Americans into 2026 with steep insurance hikes"[7], and later "Obamacare premiums surged this year. A new analysis shows it's likely to happen again in 2027"[7]. | "Launching millions ... into" is dramatic verb choice for an expiration date. The coverage centers household cost and gives little space to the improper-enrollment argument, which is the right's main claim. |
| Center on Budget and Policy Priorities | U.S. progressive policy institute, foundation-funded | 4 | "ACA Marketplace Enrollment Shrank in Nearly Every State After Premium Tax Credit Enhancements Expired"[15]. | The headline is accurate and the data are federal. The framing choice is the word "after," which invites a causal read while the improper-enrollment cleanup argument goes unaddressed. |
| The Wall Street Journal (Opinion) | U.S. right, editorial board | 8 | "The Phantom Patients of Obamacare" and "Let the Obamacare Enhanced Premium Subsidies Expire" — argues the enrollment numbers are inflated by improper sign-ups and the credits should end[13]. | "Phantom patients" does the whole argument in two words. It converts a coverage-loss story into a fraud story, and it leaves out that the large majority of enrollees are verified. Circulated by the House Budget Committee, which signals its use as a political document. |
| Protect Our Care | Democratic-aligned health care advocacy group, not a news outlet | 9 | "Premium Disaster Watch: Trump-GOP Premium Hikes Hit Working Families, Stoking 'Public Anger' Across the Nation"[18]. | "Trump-GOP premium hikes" assigns a rate increase driven substantially by medical cost growth to two named political actors. "Disaster Watch" is a campaign brand. Much of the 114% figure circulating in news coverage passes through material like this on its way from KFF. |
References
- ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire — KFF · Independent U.S. health policy research organization; endowment-funded, widely cited by both parties
- What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles — KFF · Independent U.S. health policy research organization
- How Has ACA Marketplace Enrollment Changed Across States in 2026? — KFF · Independent U.S. health policy research organization
- ACA Exchange Enrollment in 2026 (June 2026 Issue Brief) — HHS Office of the Assistant Secretary for Planning and Evaluation · U.S. federal government agency; primary data source
- Enhanced Premium Tax Credit and 2026 Exchange Premiums: Frequently Asked Questions (R48290) — Congressional Research Service · Nonpartisan legislative branch research arm serving Congress
- ObamaCare subsidies expire; premiums spike for millions: What to know — The Hill · U.S. center; Washington politics trade publication
- Health subsidies expire, launching millions of Americans into 2026 with steep insurance hikes — PBS News · U.S. center-left; publicly and philanthropically funded
- House passes three-year extension of expanded ACA subsidies — Ballotpedia News · U.S. nonpartisan elections and legislation database
- Senate Fails To Extend Enhanced ACA Subsidies; Focus Turns To House — Health Affairs · U.S. peer-reviewed health policy journal; Project HOPE
- ACA Marketplace Insurers Are Proposing a Median Premium Increase of About 15% in 2027 — KFF · Independent U.S. health policy research organization
- ObamaCare coverage costs expected to surge by 14% in 2026 — The Hill · U.S. center; Washington politics trade publication
- Conservative think tank alleges widespread ObamaCare enrollment fraud — The Hill · U.S. center; reporting on a Paragon Health Institute study
- The Wall Street Journal Editorial Board: The Phantom Patients of Obamacare — The Wall Street Journal (Opinion) · U.S. right editorial board; circulated by the Republican-led House Budget Committee
- House Chairmen: GAO Report Reveals Rampant Obamacare Subsidy Fraud — U.S. House Committee on the Judiciary · Republican-led congressional committee, characterizing a GAO audit
- ACA Marketplace Enrollment Shrank in Nearly Every State After Premium Tax Credit Enhancements Expired — Center on Budget and Policy Priorities · U.S. progressive policy institute; foundation-funded
- Obamacare premiums surged this year. A new analysis shows it's likely to happen again in 2027 — The Washington Times · U.S. right-leaning daily
- Senators say bipartisan compromise on ACA tax credits has stalled — CBS News · U.S. center-left broadcast network
- Premium Disaster Watch: Trump-GOP Premium Hikes Hit Working Families — Protect Our Care · Democratic-aligned health care advocacy campaign, not a newsroom
- ACA Insurers Are Raising Premiums by an Estimated 26%, but Most Enrollees Could See Sharper Increases in What They Pay — KFF · Independent U.S. health policy research organization
- H.R.5145 — Bipartisan Premium Tax Credit Extension Act, 119th Congress — Congress.gov · U.S. federal legislative record; primary source
- State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration — KFF · Independent U.S. health policy research organization
- ACA Enhanced Premium Tax Credits: Legislative Developments in 2025 and 2026 — Association of State and Territorial Health Officials · U.S. nonprofit membership group for state health agencies