In the United States, health care spending has been rising for years faster than wages or inflation, and one of the most visible consequences has been the dramatic increase in health insurance premiums. This is no longer merely an economic issue but a social one. For a growing number of Americans, it is increasingly uncertain whether they will actually be able to access the care they need, even if they technically have insurance coverage on paper.
The situation was made dramatically worse by the Trump administration. The federal subsidies that made Affordable Care Act marketplace coverage affordable, expanded during the pandemic through enhanced premium tax credits, expired on January 1, 2026. The Republican majority declined to extend them, and Trump refused to sign any 2025 budget agreement that would have renewed the subsidies.
The dispute escalated to the point that in 2025 the stalemate over the subsidies contributed to a prolonged government shutdown. When the shutdown was finally resolved, the funding package did not include an extension of the ACA subsidies. The reprieve never came, and the clock simply ran out. Early data show that approximately 1.4 million people have already dropped their coverage or downgraded their plans.
Analysts project that an additional 3 million could follow in March after the premium payment grace period expires. These figures were discussed during a press briefing organized by American Community Media, featuring Merith Basey, Executive Director of Patients For Affordable Drugs, Dr. Neale Mahoney, Professor of Economics at Stanford University and researcher at the Stanford Institute for Economic Policy Research, and Anthony Wright, Executive Director of Families USA.
The enhanced premium tax credits were introduced in 2021 at the height of the COVID-19 pandemic for individuals purchasing coverage under the Affordable Care Act. They were originally set to expire after three years, but Congressional Democrats fought to preserve them, emphasizing their importance for low-income consumers. The credits ultimately expired on December 31, 2025. Many families are now forced to choose between paying for health insurance and covering other basic necessities, Wright said.
“The biggest driver is high prices,” Mahoney said. “From prescription drugs to hospital care, we pay higher prices than almost anyone else in the world. Those prices show up in premiums, deductibles, and cost-sharing, placing increasing burdens on families and employers.” According to Mahoney, the average annual cost of family coverage is now about $27,000. “For $27,000, you can buy a decent car,” he said. “That’s an enormous amount of money.”
The outcome in early 2026 is precisely what policy experts warned about in 2025. Marketplace enrollees, particularly those who previously paid little or nothing because of the expanded subsidies, are now facing staggering premium increases. According to calculations by the Kaiser Family Foundation, for individuals who remain in the same plan, the net monthly premium after subsidies has increased by more than 114 percent on average, translating into more than $1,000 in additional annual costs.
This is not an abstract policy debate. The subsidies were critical because most marketplace enrollees are not there by choice but by necessity. They lack employer-sponsored insurance, lost coverage, are self-employed, work part time or in gig jobs, or live in states where the safety net is thinner. When subsidies expire, prices do not gradually creep upward. For many households, the increase appears all at once in a single bill, and coverage shifts from being expensive to being unaffordable.
The impact is already visible in enrollment data. According to the Centers for Medicare and Medicaid Services, roughly 23 million people selected ACA marketplace plans during the 2026 open enrollment period, a decline from the record level in 2025. Multiple analyses link this downturn to the expiration of subsidies and the surge in premiums. Plan selection does not equal active coverage. When January invoices arrive, many simply cannot pay and quietly drop out. The Kaiser Family Foundation has emphasized that final effectuated enrollment could decline further over the course of the year.
The expiration of subsidies affects more than just the poorest Americans. One of the key features of the expanded system was the elimination of the so-called subsidy cliff, where households slightly above a certain income threshold suddenly lost all financial assistance and faced full market prices. That cliff has now returned. Many middle-income families who had just managed to afford coverage are now squeezed out.
“When businesses face rising health care costs, they do two things,” Mahoney said. “They cut wages, or they lay off workers, or they stop hiring.” At the same time, in a largely stagnant labor market, health care remains one of the few sectors still generating job growth. Patients are also confronting higher out-of-pocket costs at pharmacy counters.
Merith Basey noted that one in three Americans cannot afford their prescription medications. “Americans pay four to eight times more than patients in other high-income countries for the same brand-name drugs,” she said. “That’s because pharmaceutical companies set the launch prices and control the market through monopoly power.”
Estimates from the Urban Institute suggest that among households earning between 250 percent and 400 percent of the federal poverty level, net premiums could more than double, rising in a typical case from $1,171 to $2,455. For those above 400 percent of the poverty level who had become newly eligible for assistance under the expanded system, net premiums are also rising sharply as the full-price structure returns.
For employer-sponsored coverage, some workers feel insulated because their employer pays a portion of the premium. In reality, employers shift costs through higher employee contributions, higher deductibles, narrower provider networks, and reduced benefits. For marketplace enrollees, the choice is harsher. Families already on the edge must decide whether to absorb the higher premium, switch to a plan with a higher deductible and weaker protections, or risk going uninsured.
The harshest consequence is not statistical but practical. When coverage becomes too expensive, people delay care. They skip preventive screenings, postpone specialist visits, ration medications, and eventually end up in emergency rooms when their condition worsens. In the American health system, delayed care almost always becomes more expensive and more dangerous, and society ultimately pays the price, often in the health and lives of the most vulnerable.
According to projections from the Congressional Budget Office and other policy analyses, the expiration of the subsidies in 2026 could increase the number of uninsured Americans by millions. The Congressional Research Service has cited a projected rise of roughly 2.2 million uninsured in 2026 alone, while other estimates foresee even larger coverage losses.
The political background is clear. The extension of the subsidies was at the center of budget battles throughout 2025. Trump and Republican leadership refused to include the extension in funding packages. Trump signed the agreement that ended the shutdown, but it excluded the provision that would have preserved affordable premiums for millions in 2026. Since then, negotiations in Washington have stalled again. Efforts to restore the subsidies repeatedly fail, partly for ideological reasons and partly because political calculation outweighs the everyday reality that the word affordable in the Affordable Care Act has become hollow for many Americans in 2026.
It is true that rising premiums are not driven solely by the expiration of subsidies. The entire American health care system is expensive. High drug prices, hospital consolidation, service charges, and administrative costs all push premiums upward. But in 2026 the turning point is unmistakable. The expiration of subsidies instantly exposed the true cost of coverage. What federal dollars had softened for years now arrives directly in household bills. Access to care is no longer merely a legal entitlement but a question of financial capacity.
In 2026 the health insurance crisis in the United States is not simply about rising prices. It is about the fact that under Trump’s presidency, Republican policy chose not to maintain the mechanism that made marketplace coverage affordable for tens of millions of people. The result is not inconvenience but loss of access. Fewer insured, more underinsured, more delayed treatment, more late diagnoses, and ultimately more Americans who are not without care because they do not want it, but because they can no longer afford it.
Annual premiums for employer-sponsored family coverage now exceed $23,000 to $24,000. According to the Kaiser Family Foundation, annual increases of 6 to 7 percent in recent years have outpaced wage growth. The average worker pays more than $6,000 to $7,000 per year directly toward family coverage, with employers covering the remainder. Individual coverage averages around $8,000 annually. Total national health care spending exceeded $4.5 trillion in 2022, nearly 18 percent of GDP, making the United States by far the highest health care spender among advanced economies.
