About 1.4 Million Fewer Americans May Now Have Health Insurance, Thanks to Spiking ACA Premiums
From the moment that Republicans currently in control of both chambers of Congress and the Presidency decided that they were committed to letting enhanced premium tax credits lapse for the Affordable Care Act, we’ve simply been waiting for the answer to a question: When premiums go through the roof, and the cost of healthcare becomes untenable for a lot of people, how many American citizens will end up without any health insurance? And now that enrollment for 2026 healthcare plans via the ACA has ended, we’re beginning to have an idea of the scope of the fallout. Data published this week by the Centers for Medicare & Medicaid Services reveals that 22.8 million Americans have signed up for ACA healthcare plans via both federal and state-operated marketplaces. That’s 1.4 million fewer people than the all-time high 24.2 million who had selected a plan by this time last year. Or in other words, that’s an early indication of how many more Americans are now likely without any health insurance.
The ACA, which Republicans succeeded in searing into the public lexicon as “Obamacare,” is a massive government program that attempts to make health insurance available to more Americans than were once covered (such as those with preexisting conditions), making it more feasible for people not covered by plans through their employers to purchase plans on their own, with costs of premiums reduced for the consumer via government subsidies. These tax credits have been part of the ACA from the beginning during the Obama administration, but the subsidies were then enhanced by the Biden administration during the COVID-19 pandemic in order to increase financial assistance and expand how many Americans would be reached. It was a successful move: The number of people enrolling in ACA markets spiked to almost double the previous figure due to the expanded credits, which the majority of people enrolled through the ACA receive. Republicans, meanwhile, have always opposed the credits as a supposed waste of taxpayer funding, preferring the obvious alternative: More Americans get sick and die.
Perhaps unintuitively, those who are losing their health insurance now are not the most likely consumers to critically need it–in theory–in the immediate future. It’s generally healthy people who are most likely to drop their health insurance when premiums rise, because they rationalize that it’s an expense they can live without in tougher economic times … right up until they get sick or injured, and are left to fend for themselves in paying the bill. This likewise creates an overall more sick pool of those covered by the ACA, which can only have a negative affect on premiums as well.
So, how much is the average ACA user likely to be paying with the expiration of the credits? Would you believe more than double what they were paying in premiums before? An analysis from KFF published in the fall calculated that the average person buying insurance from an ACA marketplace and receiving financial assistance would see their premiums rise by 114% on average, from an average of $888 in 2025 to $1,904 in 2026. It goes without saying that this is a devastating level of increase to low-income healthcare customers in particular.
DAN KOH: “$30 BILLION for 10,000 more ICE agents… that would cover all the ACA subsidies for a year. It would eliminate all medical debt. Trump is making it easier to kill people than keep people alive.”
— The Tennessee Holler (@thetnholler.bsky.social) Jan 14, 2026 at 11:09 PM
Congressional Democrats naturally attempted to make a priority of extending the premium tax credits/subsidies for the ACA during the record-setting federal government shutdown in October and November, but found themselves at an impasse in terms of attempting to negotiate a deal to reopen the federal government. They eventually folded like lawn chairs, securing nothing more than a “promise to allow a vote” on bills related to the ACA in December–I trust you can correctly assume how fruitful that promise and those discussions ended up being. In the time since, the House of Representatives and the Senate have both attempted to advance their own bills that would extend the subsidies in various ways, including one that passed through the House last week. In a true show of our national spirit of entropy, however, Senate Majority Leader John Thune has vowed to not allow that House bill to the floor, while the Senate drafts its own, likely equally doomed piece of compromise legislation. Trump, the Final Boss of Americans having health insurance, has threatened to veto anything coming across his desk on this topic.
But that’s not all! Today, on the day that ACA enrollment ends, Trump also unveiled–sort of–his own healthcare plan, dubbed in classic Trump fashion, “The Great Healthcare Plan.” The President has long promised and reneged on various plans that could replace the ACA as a primary system for getting more Americans insured, and this new announcement sees him going back to more of the same ideas he’s floated in the past: In particular, the concept of direct payments to Americans from the federal government, meant to be used by recipients on healthcare. Unsurprisingly, however, the plan’s announcement was lacking in numerous critical details about how these payments would work, who would be eligible, and whether they would ultimately save Americans more in the long run than an extension of the existing subsidies for ACA.
Our first look at Trump’s “Great Healthcare Plan” — a grab bag of proposals that falls far short of the Affordable Care Act replacement he’s long promised.
— Dan Diamond (@ddiamond.bsky.social) Jan 15, 2026 at 1:56 PM
In particular, direct payments would require the approval of Congress, and we’ve already touched on just how quickly that process has been in the second Trump administration. Speaking with reporters on Thursday, officials could offer no details on such details as “how the government would distribute money directly to patients, how large those payments would be, or who would qualify,” according to NBC News. Sounds promising.
“It’s a broken plan and a broken idea,” said Art Caplan, head of the medical ethics division at NYU Grossman School of Medicine, claiming that the plans would place the burden on consumers of effectively hunting for a deal in their healthcare. “People are easily ripped off. The average consumer doesn’t really have time to go shopping when they need to go to the hospital for a premature birth or a car accident.”
It’s little wonder that Trump likes the sound of this sort of system, given that it gives him a chance to pose and act magnanimous, in much the same way that he once demanded his name be added to COVID-era stimulus checks. Sending money “directly to patients” sounds good, because people generally like the idea, in a vacuum, of being “sent money,” and Trump no doubt loves the idea of being able to bribe the public with cash–just the thing to help sagging approval ratings. What that idea leaves out is the high likelihood that the amount of money being sent to the recipient is ultimately a drop in the bucket when faced with much higher insurance premiums and healthcare costs, resulting in the consumer paying more overall.
If you’re one of the 1.4 million Americans who may have recently let their healthcare lapse due to an inability to make ends meet, I feel for you. Here’s hoping for good health, and maybe even a passed bill or two in Congress, in 2026.