2026 ACA Marketplace Opens Amid Expiring Premium Tax Credits and Access Challenges

Open enrollment for the 2026 Affordable Care Act (ACA) health insurance marketplace has commenced amid significant challenges. The impending expiration of enhanced premium tax credits (ePTCs), which currently broaden eligibility and reduce premiums for lower-income enrollees, threatens to reverse gains made over the past decade in expanding affordable health coverage. Since the ACA's enactment in 2010, the uninsured rate has dropped from 15.4% to 8.2%, with marketplace enrollment more than doubling since 2020, driven notably by increases among Black, Hispanic populations, and women.

Policy shifts stemming from the 2025 Budget Reconciliation Bill (H.R.1) and a recent federal final rule introduce new hurdles. These include reduced enrollment windows, stricter eligibility verification, and exclusion of certain immigrant groups from premium tax credit eligibility, notably Deferred Action for Childhood Arrivals (DACA) recipients. The Congressional Budget Office estimates that 7.3 million people may lose ACA coverage in 2026 due to the ePTCs expiration, with over four million becoming uninsured by 2034.

Insurance providers have priced 2026 plans anticipating the end of ePTCs, resulting in premium increases that in some cases more than double. Automatic renewals mean many enrollees may only become aware of these hikes upon receiving bills, limiting their ability to seek lower-cost alternatives. Marginalized communities, including lawfully present immigrants and women of reproductive age, face heightened impact owing to eligibility restrictions and ongoing policy debates concerning abortion coverage within marketplace plans.

The ACA marketplace's risk pool might deteriorate as healthier enrollees drop coverage, potentially causing further premium escalations. Additionally, cuts to Navigator program funding reduce available assistance for enrollment education and transitions to Medicaid, exacerbating access challenges.

This juncture confronts policymakers with critical decisions regarding the future affordability and accessibility of marketplace coverage. Extending ePTCs and stabilizing premiums could sustain progress in lowering uninsured rates and preserving access to preventive and essential health services for diverse populations. Advocacy groups are positioned to support these aims by enhancing outreach and enrollment support during open enrollment periods.