If you buy your health insurance through the Affordable Care Act marketplace, get ready to pay—a lot more. Thanks to Congressional Republicans, the enhanced subsidies that have kept ACA premiums affordable are expiring, and some people could see their premiums more than double in 2026.
WHAT’S GOING ON: The Republican “big, beautiful bill” that Trump signed in July slashed Medicaid funding and deliberately let ACA subsidies die. The result? According to KFF, a nonpartisan health research group, ACA enrollees could pay up to 114% more in premiums next year when combined with insurer rate increases. Early enrollment data already shows people walking away from coverage or desperately switching to cheaper, worse plans.
THE DETAILS: The damage doesn’t stop at the ACA. Medicaid is getting gutted too. Changes approved under Trump’s legislation—including ending financial incentives for states to expand Medicaid—take effect in January. That means low-income adults in the 10 states that never expanded Medicaid remain trapped in a “coverage gap”: too poor for ACA coverage, not eligible for Medicaid. (SURPRISE: It’s a feature, not a bug.) Even more brutal changes like work requirements are scheduled for 2027.
“More and more people won’t have any access to care,” said Stacie Dusetzina, a health policy professor at Vanderbilt University. “That will theoretically lead to more uncompensated care for hospitals and doctors and more medical debt for people.”
BUT BUT BUT: Defenders might point to Trump’s pharma deals or a new website called TrumpRx.gov. Here’s the thing: those deals are voluntary—drugmakers can raise prices again whenever they want since nothing is codified into law. And as Dusetzina notes, “They’re lower prices for people paying cash, but still not low prices. If you can’t afford to keep your health insurance because you’ve lost access to health insurance subsidies, then it seems unlikely that you would have the resources to pay out of pocket for drugs.”
There’s a narrow bright spot: Medicare enrollees will benefit from negotiated drug prices under Biden’s Inflation Reduction Act, with out-of-pocket costs dropping over 50% on average for ten major medications. But that law was passed in 2022—before Republicans took control.
WHY IT MATTERS: This is a policy choice. Congressional Republicans had the power to extend ACA subsidies and chose not to. They could have protected Medicaid and chose not to. Millions of Americans will pay the price—literally—while the ruling class debates whether poor people deserve healthcare at all.