ACA Premium Tax Credits Expiration to Elevate Health Insurance Costs for U.S. Farmers in 2026

Expiration of enhanced premium tax credits under the Affordable Care Act (ACA) at the end of 2025 is expected to substantially increase health insurance costs for approximately 24 million Americans nationwide, including about 4 million in rural areas and a significant portion of farmers. Nearly 27% of farmers, ranchers, and agricultural managers currently rely on ACA marketplace coverage, making them vulnerable to rising premiums and higher out-of-pocket expenses. This change poses challenges by potentially slowing farm growth, straining rural healthcare services, and impacting farm business viability. Many self-employed agricultural workers lack employer-sponsored insurance, intensifying their reliance on ACA subsidies to afford coverage. Without these enhanced credits, some farmers anticipate annual premium increases that could exceed $20,000. Farm organizations, such as the Iowa Farmers Union, emphasize that these cost surges shift existing healthcare costs onto families and small businesses without addressing system inefficiencies. In response to the ACA subsidy expirations, alternative health plan options through Farm Bureau organizations in at least 13 states have garnered increased interest. These plans generally offer lower premiums—about half the cost of unsubsidized ACA plans—but are not ACA-compliant and may exclude coverage for certain pre-existing conditions or out-of-network services. Legislative efforts to extend ACA premium subsidies have faced hurdles in Congress. Recent proposals in the Senate and House aim to address individual market stability and healthcare cost drivers but have not secured passage for extending the enhanced subsidies. Political divisions persist, with Democrats supporting longer subsidy extensions, while Republican lawmakers remain divided over fiscal and policy considerations. This evolving landscape of health insurance affordability in the rural agricultural sector underscores the intersection of healthcare policy, farm economics, and rural market dynamics. Insurance professionals and policymakers should monitor ongoing legislative developments and the uptake of alternative coverage options as stakeholders navigate the post-subsidy environment.