ACA Marketplace Faces Increased Premiums and Coverage Uncertainty in 2026

A recent KFF poll reveals significant challenges facing ACA marketplace enrollees if enhanced premium tax credits expire at the end of 2024. Approximately one in four beneficiaries may forgo insurance altogether, while one in three intend to shop for cheaper plans amid potential premium cost doubling in 2026. These enhanced premium tax credits, introduced during the COVID-19 pandemic and extended by the Inflation Reduction Act, currently benefit about 22 million of the 24 million marketplace enrollees, providing substantial premium savings. Without the credits, premiums could rise an average of 114%, from $888 to $1,904 annually, posing affordability challenges for many lower-income enrollees. The political landscape has complicated the extension of these credits. Bipartisan disagreements contributed to the longest government shutdown in U.S. history this past October. While Senate leadership has indicated a willingness to hold a vote on subsidy extension in December, House leadership has not committed to a timeline. Meanwhile, Republicans are preparing an alternative healthcare proposal, expected to be presented at a party conference in December, which aims to provide options to the ACA framework and includes measures targeting pharmacy benefit managers to control drug costs. Proposed Republican plan elements involve "association health plans" for smaller businesses to collaborate on offering coverage and potential expansions of health savings accounts—measures aligned with prior policy support from former President Trump. Separately, a bipartisan group of House members introduced the CommonGround 2025 healthcare framework, proposing a two-year extension of premium savings, including a one-year extension of enhanced tax credits with modifications, targeting a legislative vote by December 18. These developments highlight ongoing regulatory and market uncertainty impacting payer and provider strategies, compliance considerations, and insurance affordability. As premium tax credit policies remain in flux, industry stakeholders must monitor legislative progress closely to anticipate regulatory changes affecting marketplace stability and consumer coverage decisions.