Millions of Americans who relied on enhanced federal subsidies to afford health insurance through the Affordable Care Act marketplace are now facing sharply higher premiums or outright loss of coverage — a slow-moving public health crisis that policy experts say could leave more than four million people uninsured by the end of 2026.
The enhanced premium tax credits, which had dramatically reduced the cost of marketplace coverage since 2021 and driven record enrollment, expired at the end of 2025. The One Big Beautiful Bill Act, signed into law in July 2025, did not extend them. For tens of millions of marketplace enrollees, the first sign was a premium bill in January 2026 that looked nothing like last year's.
