Understanding the Impacts of ACA Subsidy Expiration on Marketplace Stability and Patient Care

Enhanced premium tax credits expired for 2026, reducing marketplace affordability and increasing the number of patients with unstable or no insurance.

Exchange enrollment fell to 15.6 million for 2026, down from roughly 16 million the prior year, according to exchange/CMS enrollment reports.

Projected premiums are expected to rise to an average of $1,904 annually in 2026, up from $888 in 2025 (based on underlying actuarial and government estimates), effectively more than doubling typical plan cost exposure for many patients.

The combination of falling enrollment and steep premium increases threatens coverage continuity and raises immediate clinical risks. Common reasons patients may forgo coverage despite clinical need include direct cost strain, administrative barriers to enrollment or renewal, confusion about changing eligibility, and a perception of low immediate need for care.

Together, these factors increase the risk of delayed presentations, lapses in medication adherence, and interrupted preventive care. Consider screening for affordability barriers at intake and reinforcing follow-up plans when coverage is uncertain.

Key Takeaways:

• Early data show marketplace enrollment down to 15.6 million and a projected more-than-doubling of average annual premiums, increasing patient financial exposure.
• People who relied on enhanced premium tax credits and those near subsidy cliffs face the highest risk of losing coverage — prioritize navigator referral and enrollment counseling for these patients.
• High-confidence signals point to worsening coverage continuity and reduced take-up; monitor enrollment trends, expand proactive affordability screening, and bolster medication-cost counseling within clinic workflows.