Millions of ACA enrollees will face steep premium hikes in 2026 as insurer rate increases collide with the expiration of enhanced federal subsidies.

As health insurance premium costs have taken center stage this fall, you may have seen seemingly conflicting reports about how much premiums are increasing, especially for ACA marketplace plans. This isn’t a reporting error. Instead, it reflects a double whammy of increases that more than 20 million ACA enrollees are poised to face in 2026.

To understand what’s happening, it helps to think of ACA premium increases as a one-two punch.

The first hit comes from the overall increase in health insurance premiums for 2026. On average, insurers raised premiums for ACA marketplace plans by roughly 26 percent from 2025 to 2026. This increase reflects a rise in the total cost of coverage, the full premium paid jointly by enrollees and the federal government through subsidies, not just what individuals pay out of pocket.

Premium increases are not new. Insurers raise rates every year. But the 2026 hike is striking: more than three times the 7 percent increase in 2025 and the 6 percent increase in 2024. Insurers have attributed roughly four percentage points of this increase to the anticipated expiration of the enhanced premium tax credits, arguing that enrollment will decline and that sicker, higher-cost enrollees will make up a larger share of the risk pool. Insurers also cite provider consolidation and high pharmaceutical prices as drivers of higher premiums.

These explanations deserve scrutiny. As Wendell Potter recently documented, the seven largest private insurance corporations have collectively taken in more than $10 trillion in revenue since 2014 with revenues steadily increasing each year. Against that backdrop, claims that today’s premium spikes are unavoidable or purely defensive ring hollow.

The second hit falls directly on consumers who currently rely on enhanced premium subsidies (in the form of tax credits) to make coverage affordable. Those enhanced subsidies, first made available during the pandemic, are set to expire at the end of 2025, and Congress appears poised to let them lapse without an extension. If that happens, many enrollees will see the tax credits that lower their monthly premiums shrink dramatically or disappear altogether. Taking this into account, the amount people pay out of pocket for ACA premiums is expected to increase by an estimated 114 percent in 2026. And that is just for the premiums. People enrolled in ACA plans will also have to spend hundreds if not thousands of dollars out of their own pockets in deductibles and copays before their coverage kicks in.

This double whammy will have drastic, and potentially deadly, consequences for millions of Americans. I am already seeing panic from people in my own community and across the country, echoed daily on social media. Yet Congress has taken no action to cushion the blow. The Republicans leading both the House and the Senate are leaving Washington without extending the enhanced tax credits, even as the clock runs out.

This is an abdication of Congress’s responsibility to represent the people it serves, people who have been clear about what they want and need: health insurance they can actually afford. Rather than getting bogged down in partisan gridlock or abstract market ideology, Congress must act now to extend the enhanced premium tax credits. That extension should be treated as an urgent bridge to a real fix to our health care system; one that reduces dependence on Big Insurance, lowers costs for patients, and ensures that no one is forced to go without care.