Former US President Barack Obama marked the 16th anniversary of the Affordable Care Act (ACA) on Monday by calling the day he signed it into law 'one of my proudest moments as president.'
But for the 22 million Americans who relied on enhanced subsidies to afford their coverage, the timing couldn't be worse.
'A First Step' That's Now Walking Backwards
In a post on X, Obama looked back on the ACA's legacy, noting it gave millions access to health care 'some for the first time,' barred insurers from denying coverage over pre-existing conditions, and allowed young adults to stay on their parents' plans until age 26.
He also acknowledged the law's limits, writing that 'the ACA was always meant to be a first step. We still have to do more to expand access and make health care more affordable for everyone.'
The day the Affordable Care Act passed was one of my proudest moments as president, because it meant that millions of Americans would have access to health care, some for the first time.
— Barack Obama (@BarackObama) March 23, 2026
The ACA also prevented insurance companies from denying people with pre-existing conditions…
That admission lands differently in 2026. The enhanced premium tax credits that made ACA marketplace coverage affordable for millions expired on 31 December 2025 after Congress failed to extend them. The credits were first introduced under the American Rescue Plan Act in 2021 and later extended through the Inflation Reduction Act.
Premium Payments Set to More Than Double
The financial toll is already clear. KFF, the nonpartisan health policy research organisation, estimates that subsidised marketplace enrollees will see their premium payments rise by an average of 114%, from $888 (£663) annually in 2025 to $1,904 (£1,421) in 2026. For older adults nearing retirement, the picture is far grimmer. A 60-year-old couple earning around $85,000 (£63,466) a year could face annual premium increases exceeding $22,600 (£16,874).
The Urban Institute projects that 7.3 million people will lose their ACA marketplace coverage this year, with 4.8 million of them becoming entirely uninsured. Younger, healthier enrollees are expected to drop out first, pushing premiums even higher for those who remain.
The Shutdown That Sealed the Deal
The subsidies became the central battleground during the US government shutdown that began on 1 October 2025 and lasted 43 days. Senate Democrats refused to approve a spending bill that didn't include an extension of the enhanced tax credits. When a bipartisan deal was struck to reopen the government in November, it contained no agreement on the subsidies' future.
A December vote in the Senate proved the final blow. Democrats proposed a three-year extension, but the measure failed 51-48, falling short of the 60 votes needed to advance. Four Republican senators crossed party lines to support it, but the rest of the caucus held firm.
Bipartisan talks continued into early 2026 but stalled over disagreements on abortion coverage language and competing proposals to redirect funds into health savings accounts.
Trump's 'Unaffordable Care Act' and What Comes Next
President Donald Trump used his 24 February State of the Union address to attack the very law Obama celebrated weeks later. Trump called the ACA the 'Unaffordable Care Act', arguing it enriched insurance companies at the expense of patients.
He proposed redirecting federal subsidies into personal health savings accounts, telling Congress, 'I want to stop all payments to big insurance companies and instead give that money directly to the people.'
ACA marketplace enrolment reached a record 24.3 million in 2025, more than double the 11.4 million enrolled in 2020. That growth was driven almost entirely by the enhanced subsidies that are now gone.
Obama's words that 'we still have to do more' were meant as a call to build on the ACA's progress. For millions now facing doubled premiums and dropped coverage, they serve as a sharp reminder of just how much ground has already been lost.
