Expiring ACA Subsidies Threaten Behavioral Health Access and Strain Emergency Care

The expiration of the enhanced Affordable Care Act (ACA) subsidies at the end of 2025 is projected to increase premiums for approximately 22 million Americans starting January 1, 2026. Legislative efforts to extend these subsidies or provide alternatives like health savings accounts did not advance in the Senate. This development poses significant concerns for access to behavioral health services, as higher premiums may lead to coverage losses among individuals relying on mental health care. Behavioral health experts highlight that emergency departments (EDs) are already challenged by patient boarding—where psychiatric patients await inpatient services within the ED. Prolonged ED boarding times, especially among older adults, have been linked to heightened risks such as mortality, delirium, and delays in treatment, compounding clinical and operational stress on health systems. The loss of coverage may exacerbate ED utilization for psychiatric care, increasing uncompensated care burdens for hospitals and health systems, particularly in rural areas. About 20% of psychiatric ED visitors experience repeat visits within six months, reflecting ongoing gaps in community-based mental health services and social support. The expiration of subsidies is likely to intensify these challenges without legislative relief. To mitigate these pressures, experts recommend that hospitals and community providers pursue partnerships with outpatient mental health services, federally qualified health centers, and telepsychiatry platforms. Employing such collaborations may help address gaps in care continuity and reduce boarding times. As the ACA open enrollment period for 2026 coverage has closed, urgency remains for congressional intervention to prevent premium spikes and insurance coverage disruptions. However, legislative uncertainty persists with limited prospects for immediate subsidy extensions that could ease the strain on behavioral health access and emergency care systems in the coming year.