The next month will be critical to health insurers and their customers with individual coverage under the Affordable Care Act as the Republican-led Congress decides whether to extend tax credits or trigger a big price hike in premiums for millions of Americans. In this photo is the U.S. Capitol is shown June 5, 2003 in Washington, DC. Both houses of the U.S. Congress, the U.S. Senate and the U.S. House of Representatives meet in the Capitol. (Photo by Stefan Zaklin/Getty Images)
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The next month will be critical to health insurers and their customers with individual coverage under the Affordable Care Act as the Republican-led Congress decides whether to extend tax credits or trigger a big price hike in premiums for millions of Americans.
The subsidies, or tax credits, make health insurance premiums more affordable for individuals and were enhanced thanks in part to moves by the Biden administration and the Democratic-controlled Congress, which passed the Inflation Reduction Act of 2022, allowing more Americans to buy coverage. The enhanced subsidies helped enrollment in the ACA’s individual coverage, also known as Obamacare, eclipse a record 24 million Americans and help its popularity hit all-time highs.
Should the Donald Trump administration and the Republican-controlled Congress eliminate or reduce subsidies, premium costs could soar by double-digit and even triple-digit percentages for next year, health insurance executives say.
Health insurance executives have been sounding the alarm of potential 2026 rate increases in recent weeks.
“Our initial rate filings already reflected program integrity changes and expiration of enhanced premium tax credits,” Oscar Health chief executive officer Mark Bertolini told analysts earlier this month during the company’s second quarter earnings call. “We expect the market will have double-digit rate increases next year.”
To be sure, health insurance companies like Oscar are already calculating big premium increases should Congress not extend the tax credits. Oscar is one of the nation’s biggest providers of individual coverage with more than 2 million customers.
Rival insurers, including Centene, Cigna, UnitedHealth Group’s UnitedHealthcare and an array of Blue Cross and Blue Shield plans are also expected to raise premiums for individual policy holders substantially if the enhanced subsidies go away. A KFF analysis of preliminary rate filings submitted by more than 100 “ACA Marketplace insurers” in 19 states and the District of Columbia showed “insurers are requesting a median premium increase of 15% for 2026, which would represent the largest hike in premiums since 2018, the last time policy uncertainty contributed to sharp premium growth.”
But America’s Health Insurance Plans (AHIP), the lobby and trade group for health insurers, says “middle-income individuals and families could see average premium increases of 75% or more than $700 per person.”
Meanwhile, the Congressional Budget Office estimates more than 4 million people could lose coverage if the subsidies aren’t extended.
Health insurers say Congress must act before Sept. 30 given the time needed to finalize coverage options ahead of the beginning of open enrollment – the annual period of time Americans can select new benefits for the following year – which begins Nov. 1.
“Enhanced premium tax credits have made coverage more affordable and helped millions of Americans gain health insurance through the individual market,” AHIP says in outlining the stakes for Americans with individual coverage If Congress lets the subsidies expire. “But unless Congress acts, these credits will expire at the end of 2025, causing a sudden and severe rise in premiums and leading many to forgo coverage altogether.”
Open enrollment starts November 1 and runs to December 15 for coverage to start January 1, 2026.
Source: https://www.forbes.com/sites/brucejapsen/2025/08/25/lobby-intensifies-to-extend-obamacare-subsidies-and-stop-sticker-shock/
