Photo: HealthCare.gov
Affordable Care Act insurers are expected to increase premiums by almost 20% due to the end of premium tax credits, the effect of the One Big Beautiful Bill Act and new marketplace rules, according to the Center on Budget and Policy Priorities.
This is on top of rising healthcare and prescription drug costs.
These changes have led insurers to propose average gross premium increases of 18%, the largest premium hikes since 2017, the report said.
More than 22 million people rely on ACA coverage for their health insurance, according to the report.
The HealthCare.gov site has posted this notice: "During the government shutdown, if you have a 2025 health insurance plan, continue using your plan and providers. If you don’t have a plan, you can use this site to apply for and access coverage."
WHY THIS MATTERS
Five key changes await consumers when they sign up for Affordable Care Act plans, said the Center on Budget and Policy Priorities report. Open enrollment begins on Nov. 1.
The biggest reason for a spike in premiums is the expected end of the enhanced premium tax credits (PTC), which has driven record enrollment, the report said. Without congressional action, these credits expire at the end of the year.
The partisan battle over whether to extend the tax credits is one reason for the government shutdown.
The Congressional Budget Office estimates that if the enhanced premium tax credits expire, an estimated 4 million people would lose coverage and become uninsured.
Ninety-three percent of ACA enrollees receive premium tax credits.
ACA growth has been concentrated among Blacks and Latinos, people with low incomes and those living in states that haven’t expanded Medicaid.
Premium tax credits have been available to people with incomes greater than four times the federal poverty level if they face very high premiums. About 90% of enrollees have incomes below this level, and nearly half of enrollees have incomes below twice the poverty level.
“Extending PTC enhancements would overwhelmingly benefit low-and moderate income households,” the report said
An estimated 3 million more people are expected to lose coverage and become uninsured due to the One Big Beautiful Bill Act and a separate marketplace regulation finalized in June. Both create barriers to enrollment, the report said.
The One Big Beautiful Bill Act creates additional barriers to coverage for immigrants who are living lawfully in the United States, the report said.
The new marketplace regulation prohibits people with Deferred Action for Childhood Arrivals (DACA) from enrolling in marketplace coverage.
The uninsured rate among people who are immigrants declined 36% from 2010 to 2023. The new law will further reduce health insurance coverage for immigrants in 2027.
THE LARGER TREND
Open enrollment for 2026 begins on Nov. 1. People typically begin to see their premiums and estimated premium tax credit amounts in September and October.
Because of the uncertainty this year about whether the PTC enhancements will continue, notices from marketplaces and from insurers might not include information about the household’s monthly premiums for 2026, the report said. As a result, people may not learn what their 2026 premiums will be until they return to the marketplace during open enrollment.
More than half of enrollees were automatically re-enrolled last year. Consumers who rely on automatic enrollment this year may not learn about their 2026 premiums until they receive their first bill for January coverage, at which point they will have just a few weeks to make changes before open enrollment ends on Jan. 15.
Email the writer: SMorse@himss.org