Expiring ACA subsidies will affect these Americans most

It’s a near certainty that enhanced subsidies for health insurance purchased on the Affordable Care Act marketplace will expire at year’s end amid political gridlock — and some consumers are poised to be hit especially hard by the loss.

The expiration of the enhanced subsidies would raise insurance premiums for roughly 22 million recipients, or about 92% of ACA marketplace enrollees.

KFF, a nonpartisan health policy research group, estimates the average recipient would see their premiums more than double in 2026 if the subsidies disappear.

But certain people — including early retirees, small-business owners, middle-income consumers, Black and Latino households, and residents of many states that voted for President Donald Trump in 2024 — would be more financially exposed to a subsidy lapse, according to health experts.

An expiration would “affect anyone getting those subsidies,” said Nick Fabrizio, a health policy expert and associate teaching professor at Cornell University’s Jeb E. Brooks School of Public Policy.

“Then it’s a question of who’s in those groups: Who are the most vulnerable?” Fabrizio said.

There’s a chance Congress may act to extend the subsidies early next year.

Earlier this month, a handful of Republicans in the House of Representatives broke ranks to join with Democrats and force a vote in the chamber in January on extending the subsidies.

Even if the House measure succeeds, it’d face long odds in the Senate. Senate Republicans on Dec. 11 already voted down a three-year extension of enhanced ACA subsidies that Democrats proposed. Republicans have said they’re opposed due to factors like cost and fraud, and have also cited an unwillingness to extend a program enacted during the Covid-19 pandemic.

“It’s virtually guaranteed at this point the subsidies will expire” at the end of 2025, said Emma Wager, a senior policy analyst at KFF who specializes in the Affordable Care Act. “What happens [in Congress] in January remains to be seen.”

Here’s who will be most affected by a lapse in enhanced subsidies.

ACA subsidies, also known as premium tax credits, have been available since 2014.

Congress offered a temporary enhancement to those subsidies in 2021 as part of a Covid-19 relief package. The next year, lawmakers extended the enhanced subsidies through 2025.

The enhanced subsidies both boosted the value of the premium tax credit and made it available to more households.

The policy also capped the amount that households pay out of pocket for health insurance premiums at 8.5% of their annual income, down from almost 10% before the enhanced subsidies took effect.

Further, the enhancement eliminated the so-called “subsidy cliff.”

Previously, households with an income exceeding 400% of the federal poverty level — more than roughly $63,000 for an individual and $129,000 for a family of four in 2025 — were ineligible for any premium subsidies.

If ACA enrollees earned even $1 more, they paid the full, unsubsidized insurance premium.

The subsidy cliff is set to return in 2026.

“The people who will see their premium payments increase by the largest amounts are definitely the ones who are just over 400% of the federal poverty line,” Wager said.

The Urban Institute estimates that average annual premiums for consumers over the subsidy cliff would jump to about $8,500 in 2026 from about $4,400 this year.

People just barely over the cliff would be hit harder than those who earn even higher incomes, Wager said. That’s because they’d be paying the same unsubsidized insurance premium as higher earners but would have smaller incomes to do so, she said.

Millions of people are at the edge of the subsidy cliff.

In 2025, about 3% of ACA enrollees — nearly 725,000 people — earned between 400% and 500% of the federal poverty line, for example, according to a Bipartisan Policy Center analysis of federal data.

 Another 7% — about 1.8 million people — earned 300% to 400% of the poverty line, it found. That equates to more than about $47,000 to per year for an individual and about $96,000 for a family of four.

Many older adults who retire before they’re eligible for Medicare at age 65 buy health insurance on the ACA marketplace.

In 2025, about 24% of ACA enrollees were at least 55 years old, according to the Bipartisan Policy Center analysis.

Insurance premiums increase significantly with age, experts said. Insurers are allowed to charge older adults more than younger consumers, and often do because older people tend to use more health care, experts said.

In most states, a 64-year-old pays three times as much for coverage as younger consumers who are aged 21 to 24, according to the BPC.

The difference is “very substantial,” Wager said. “If they lose their subsidy, or a good portion of it, they’ll be on the hook for a lot more money.”

A 60-year-old whose income is just over the subsidy cliff would see their annual out-of-pocket insurance premiums jump from 8.5% of their income in 2025 to more than 23% of their income in 2026, according to KFF.

For example, a 60-year-old earning $64,000 — about 409% of the federal poverty level — would pay about $14,900 in annual premiums in 2026, according to KFF. By comparison, a person with the same age living in the same place earning $62,000 would pay about $6,200 out of pocket since they qualify for subsidies, it found.

Small businesses are less likely than larger ones to offer employer-sponsored health insurance, meaning entrepreneurs and their workers are more likely to get their health coverage through the ACA marketplace, according to KFF.

Nearly half — 48% — of all adults under age 65 enrolled in a marketplace health plan are self-employed entrepreneurs, small business owners or are employed by a small business with fewer than 25 workers, according to KFF.

By comparison, 16% of all adults under age 65 nationwide are employed by a small business or are self-employed, it found.

Some occupations — chiropractors, musicians and singers, real estate brokers, farmers and ranchers, dentists, and manicurists and pedicurists, for example — rely on the ACA marketplace more heavily than others, according to KFF.

About 34% of chiropractors, for example, get their coverage through the individual marketplace, it said.

Experts credit the enhanced subsidies for most of the tremendous growth in ACA enrollment seen in recent years.

ACA enrollment has more than doubled since 2020, from roughly 11 million to a record-high 24 million in 2025, according to a KFF analysis of federal data.

Most of that enrollment boost came in states Trump won in the 2024 election.

About 88% of the total growth in the ACA marketplace since 2020 — 11.4 million out of 12.9 million new enrollees — is from such states, according to KFF.

On average, enrollment increased by 157% in the states that voted for Trump, while states that voted for former Vice President Kamala Harris saw a 36% increase, KFF found. Enrollment more than tripled in Texas, Mississippi, West Virginia, Louisiana, Georgia and Tennessee, it said.

ACA enrollees in Florida received $31.7 billion of premium tax credits in 2025, the highest state tally, while enrollees in Texas got $24.1 billion, the second-highest state total, according to KFF estimates. The two states accounted for about 39% of the total $143.9 billion paid to all Americans in 2025, KFF estimates.

If enhanced subsidies expire, certain groups with a higher uninsurance risk, including Black and Latino consumers, will be disproportionately impacted, according to the Bipartisan Policy Center.

The share of total consumers enrolled in an ACA marketplace health plan increased to 22% in 2025 among Hispanics/Latinos, up from 18% in 2020, according to BPC, citing federal data. Among Black consumers, the share rose to 10% in 2025 from 8%.

While they account for a relatively small share of ACA enrollees relative to white consumers, who accounted for 52% of total enrollees in 2025, “recent coverage gains could be lost if the enhanced [subsidies] expire,” according to BPC.

“When enhanced subsidies were enacted in 2021, the size of the market grew substantially because people could afford to join for the first time,” KFF’s Wager said. “There’s been vast growth, concentrated especially in Southern states, which have larger Black and Latino populations.”