Shame on Republican lawmakers. Not only will 10-11.8 million Americans lose their Medicaid coverage due to Republicans’ One Big Beautiful Bill Act according to the Congressional Budget Office, but in addition about 8 million people will lose their subsidized ACA coverage which could push some 5 million to go uninsured.
Republicans rejected Democrats proposal to extend the ACA credits in the shutdown impasse. A deal must be made by the end of December to extend the ACA credits.
What happens if the ACA credits are not extended?
Consequences of more uninsured
Those who forego coverage may delay or avoid seeking treatment, which can result in worse health outcomes and higher costs in the long run. For Americans with chronic health conditions like high blood pressure or diabetes, going uninsured could be a matter of life and death.
What kind of numbers are we looking at? The Center on Budget and Policy Priorities projects an increase in preventable deaths to approximately 51,000 per year due to the combined impact of legislation on Medicaid cuts and ACA marketplace coverage reduction.
This increased uninsured rate could have other consequences besides poor health outcomes, including higher Medicare costs. State and local governments could end up bearing the brunt of these ACA changes. Basically, ending the ACA credits could amount to further shock to the overall healthcare system from the Medicaid cuts passed earlier in the year.
A rise in uninsured individuals also would lead to more uncompensated care in hospitals and clinics causing financial strain, potentially leading to reduced services or higher costs for all patients.
Increased cost for health insurance
For those who are able to pay the additional costs for coverage with the ACA, marketplace estimates say that premiums could double—or even triple— for those 22 million Americans receiving enhanced subsidies.
Some examples of increased costs:
*Average enrollee impact: Annual premiums would jump from $888 in 2025 to $1,904 in 2026, an increase of $1,016 per year.
*Middle-income families: A family of four earning $130,000 (just above 400% of the federal poverty level) would see monthly premiums rise from $921 to $1,998—an annual increase of about $12,900.
*Lower-income individuals: Someone making $28,000 would see their share of premiums rise from 1% of income ($325 annually) to nearly 6% ($1,562 annually).
Premium increases are slated to go into effect next year if the tax credits lapse after Dec. 31.
This increase in insurance cost comes at a time when inflation is on the rise, forcing Americans to choose between paying for coverage or other essential expenses such as housing, food, or utilities.
The expiration of ACA credits threatens the gains made under the ACA in expanding access to affordable healthcare that Democrats have been pushing for.
Majority of Americans support extending the ACA credits
About three-quarters of Americans (roughly 74–78%) support extending the enhanced ACA premium tax credits, according to multiple KFF polls in 2025. Support is strongest among Democrats but still includes a majority of independents and about half of Republicans.
By party affiliation: Democrats: 91–94% support extending the credits, Independents: 76–80% support, Republicans: support dipped from 59% in September to about 50% in November. These are exceptionally high numbers of support for any policy.
Republicans could pay in the midterms
The combination of both cutting Medicaid and now ending the ACA tax credits could be a double whammy of political suicide for the Republican party. Americans are fixed and focused on affordability and will demand it in the midterms. And raising the cost of health insurance doesn’t help anyone.
Republicans have focused on repealing and replacing the ACA but have not united behind a single comprehensive alternative plan. Affordable healthcare will certainly be among the top issues for both the midterms and 2028 presidential election.
If Republican lawmakers can read the tea leaves and know what’s good for them, it’s not too late with regard to extending the ACA tax credits. While Republicans in both the House and the Senate have so far refused to engage on extending the tax credits as part of a deal that ended the shutdown, it’s not too late for Congress to take that step if they come around to it. They can even reinstate the subsidies after they expire.
But even if the subsidies are extended, it may already be too late for some prospective enrollees who have had seen next year’s higher prices and have made other plans.
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