Millions could face higher ACA premiums, lower subsidies: "There will be sticker shock"

Most of the 24 million people in Affordable Care Act health plans face a potential one-two punch next year — double-digit premium increases along with a sharp drop in the federal subsidies that most consumers depend on to buy the coverage, also known as Obamacare.

Insurers want higher premiums to cover the usual culprits — rising medical and labor costs and usage — but are tacking on extra percentage point increases in their 2026 rate proposals to cover effects of policy changes advanced by the Trump administration and the Republican-controlled Congress. One key factor built into their filings with state insurance departments: uncertainty over whether Congress allows more generous, COVID-era ACA tax subsidies to expire at the end of December.

"The out-of-pocket change for individuals will be immense, and many won't actually be able to make ends meet and pay premiums, so they will go uninsured," said JoAnn Volk, co-director of the Center on Health Insurance Reforms at Georgetown University.