At the end of 2025, enhanced federal subsidies that had been lowering health insurance premiums for millions of Americans expired. Congress did not renew them. The results are now visible in the data: roughly five million people have dropped their marketplace coverage, premiums more than doubled for those who stayed, and the share of Americans without health insurance is rising for the first time in years.
This did not have to happen. Democrats passed a three-year extension through the House in January. Senate Republicans blocked it.
What the Subsidies Were
The enhanced premium tax credits were first enacted during the pandemic and extended through the Inflation Reduction Act. They significantly reduced the monthly cost of health insurance purchased through ACA marketplaces, making coverage affordable for people who previously could not afford it or had let it lapse.
At their peak, the subsidies brought record enrollment. By the end of 2025, 24.3 million people were covered through the marketplaces, the highest number in the program’s history.
What Happened When They Expired
When the subsidies lapsed at the start of 2026, premiums jumped. For subsidized enrollees who stayed in the same plan, average annual premium payments rose 114 percent, from roughly $888 per year to $1,904. That is an increase of more than $1,000 per year for people already stretching to afford coverage.
The impact was sharper for older enrollees. A 60-year-old earning $65,000 per year is now paying $10,389 more annually than they were in 2025. Someone earning $28,000 per year saw their annual premium cost rise from $325 to $1,562.
More than one in five people who enrolled during the last open enrollment period could not afford their first month’s premium and lost coverage before their insurance even began. A KFF survey conducted in March found that roughly one in ten people who had marketplace coverage last year are now uninsured. The Urban Institute and Commonwealth Fund estimated the coverage loss at approximately 4.8 million people.
What Congress Did
Democrats tried to prevent this. In January, 17 House Republicans joined Democrats to pass a three-year extension of the enhanced subsidies, 230 to 196. Speaker Mike Johnson had initially blocked the bill from even reaching the floor, and the final passage came only after moderate Republicans broke with leadership.
The bill went to the Senate. It failed 51 to 48. Only four Republicans — Susan Collins of Maine, Josh Hawley of Missouri, and Lisa Murkowski and Dan Sullivan of Alaska — crossed party lines. The extension died.
Republicans then passed the Big Beautiful Bill, which did not restore the subsidies and went further in the other direction. The law ended a special enrollment period for low-income individuals and stripped away limits on how much excess subsidy money households must repay, meaning some families are now facing large tax bills on top of higher premiums.
Who Is Being Hit Hardest
Adults between 50 and 64 are among the most affected. They make up a large share of marketplace enrollment, and their premiums are already higher because they rise with age. Many in this group are too young for Medicare and do not have employer coverage. The marketplace was often their only option.
The coverage losses are also concentrated among people with lower and middle incomes who qualified for the enhanced credits but not for Medicaid. These are precisely the people the subsidies were designed to reach.
The Bigger Picture
At the current trajectory, the Urban Institute projects total marketplace enrollment will fall from 24 million today to 12.5 million by 2028. The share of Americans without health insurance is expected to climb from 7.6 percent in 2025 to 10.4 percent by the end of the decade.
The subsidies that expired were not permanent programs. They required congressional action to continue. Democrats brought that action to a vote. Republicans blocked it. The five million people who have lost coverage since January are the direct result of that decision.