Doug Butchart’s wife Shadene has ALS. Their ACA marketplace insurance covers treatments that cost thousands monthly. But the 67-year-old Illinois resident told ABC News something that keeps him awake at night: “We can’t afford to not have insurance.”
Here’s his problem. The enhanced premium tax credits that make his family’s coverage affordable expire December 31, 2025. And with Washington stuck in a three-week government shutdown, nobody’s voting to extend them.
Analysis from the Kaiser Family Foundation says premium payments could more than double next year without those subsidies. For millions relying on marketplace plans, that’s not a budget adjustment—it’s a potential coverage crisis.
Why December 31 Matters More Than You Think
Enhanced ACA premium tax credits showed up during COVID-19 to help Americans afford marketplace insurance. They worked. Premiums dropped for most buyers, enrollment jumped, and people like the Butcharts could actually get comprehensive coverage.
But Congress wrote those enhancements with an expiration date: end of 2025. That’s 10 weeks away.
Without an extension, here’s what changes January 1:
- Your subsidy shrinks dramatically or disappears entirely, depending on your income bracket and family size.
- Premium costs could more than double according to KFF’s modeling—turning a $200 monthly payment into $450 or more.
- Millions face a choice: pay significantly more, downgrade to bare-bones coverage, or drop insurance altogether.
The subsidies lowered premiums by limiting what percentage of income goes toward health insurance. When they expire, those income-based calculations revert to pre-pandemic formulas that require higher out-of-pocket costs.
The Federal Shutdown Connection Nobody’s Talking About
Washington’s been closed for three weeks now. Budget negotiations stalled. And that directly affects your health insurance.
Democrats want the subsidy extension included in any government funding deal. Republicans are demanding a clean funding bill first, then separate votes on other issues. Meanwhile, the calendar keeps moving toward December 31.
This isn’t abstract political theater. Every day without a deal increases the risk that marketplace insurers can’t properly price 2026 plans or that consumers face last-minute scrambling during open enrollment.
State insurance commissioners need clarity. Insurers need time to adjust rates. Consumers need to make informed decisions about 2026 coverage during the enrollment window that runs through mid-December in most states.
Who Gets Hit Hardest by the Subsidy Cliff
Not everyone benefits equally from enhanced subsidies, so the pain won’t spread evenly either.
Most vulnerable:
- People with chronic conditions requiring expensive ongoing care—exactly like Shadene Butchart’s ALS treatment. Miss coverage for even one month and medical debt piles up fast.
- Older adults not yet Medicare-eligible face the highest baseline premiums. A 60-year-old in many markets already pays 3-4 times what a 30-year-old does. Lose subsidies and monthly costs become impossible.
- Middle-income families just above Medicaid thresholds who don’t qualify for employer coverage. Enhanced subsidies made marketplace plans affordable for the first time. Losing them means going back to being uninsured.
The Department of Health and Human Services estimates roughly 3.2 million Americans could lose coverage if subsidy enhancements expire and premiums jump as projected.
What KFF’s Premium Analysis Actually Shows
Kaiser Family Foundation ran the numbers. Their modeling shows premium payments more than doubling isn’t worst-case thinking—it’s the expected outcome for many marketplace consumers.
Here’s how it breaks down:
| Income Level | Current Premium (with subsidies) | 2026 Premium (without subsidies) | Increase |
|---|---|---|---|
| 150% of poverty line | $50-75/month | $150-200/month | +200% |
| 250% of poverty line | $150-200/month | $400-500/month | +150-200% |
| 400% of poverty line | $300-400/month | $600-800/month | +100% |
Those percentages represent real money most families don’t have sitting around. A sudden $300-400 monthly increase wipes out grocery budgets, car payments, or emergency savings.
The analysis assumes no changes to underlying insurance costs. If medical inflation continues or insurers raise rates anticipating subsidy loss, actual 2026 premiums could climb even higher.
Your Immediate Action Steps Before December 31
The subsidy extension might still happen. Or it might not. Either way, you need a plan.
By November 15:
- Log into your Healthcare.gov account (or your state marketplace) and review current subsidy amounts.
- Calculate what you’d pay without subsidies using the marketplace’s “browse plans” tool—set subsidy slider to zero.
- Contact your current insurer directly to ask about 2026 rates and whether they’re assuming subsidy continuation.
By December 1:
- Research alternatives: employer coverage (even if more expensive, stability matters), spouse’s employer plan, professional association group plans.
- For those near Medicare age (63-64), evaluate early retirement to get coverage sooner versus paying inflated premiums for 1-2 years.
- Check if you’d newly qualify for Medicaid in your state if income drops due to retirement or job changes.
If subsidies aren’t extended by mid-December:
- You’ll face hard choices during the enrollment deadline (usually December 15 for January 1 coverage). Some families may need to budget healthcare as a larger expense. Others might risk going uninsured and paying the tax penalty, though that’s risky with medical costs.
- Consider high-deductible plans paired with Health Savings Accounts if you’re relatively healthy. Premium savings might offset higher out-of-pocket maximums.
What Congress Could Still Do (And Hasn’t)
Three legislative paths exist:
Full extension: Keep enhanced subsidies through 2026 and beyond. Costs federal budget roughly $50 billion annually, so Republicans resist without offsetting cuts elsewhere.
Partial extension: Scale back enhancements but don’t eliminate them entirely. Premiums would still rise, just not double. Compromise option that satisfies nobody.
Short-term patch: Extend for 3-6 months to buy negotiating time. Markets hate uncertainty, though, so insurers would struggle with mid-year rate adjustments.
Democrats frame this as healthcare access for working families. Republicans call it unsustainable government spending. Both sides use the shutdown to leverage their position, which means consumers get squeezed in the middle.
Frequently Asked Questions
Will ACA marketplace plans still exist in 2026 without subsidies?
Yes. The ACA marketplace and insurance plans continue regardless of subsidy status. What changes is YOUR cost. Plans will still be available through Healthcare.gov and state exchanges, but you’ll pay the full premium amount instead of subsidized rates. Insurers aren’t leaving the marketplace—they’re just charging consumers more because federal assistance dropped.
Can I switch to employer coverage mid-year if subsidies expire?
Only during your employer’s open enrollment period or if you qualify for a special enrollment period due to loss of other coverage. The subsidy expiration itself doesn’t automatically create a special enrollment window for employer plans. Talk to your HR department about timing before you drop marketplace coverage.
What happens to people who can’t afford the higher premiums?
Three likely outcomes based on past subsidy reductions: some downgrade to catastrophic or bronze plans with higher deductibles, others drop coverage and hope they stay healthy, and many accumulate medical debt when unexpected health issues arise. KFF projects 3.2 million could lose coverage completely. Those with chronic conditions face the worst scenarios since going uninsured isn’t really an option.
How quickly could Congress act if they wanted to extend subsidies?
Technically, within days if both chambers agree and the president signs. The enhanced subsidy extension could attach to a government funding bill or pass as standalone legislation. Past extensions happened with just weeks’ notice. But “could” and “will” are different things. The three-week shutdown shows political will is the bottleneck, not legislative mechanics.
Should I pay the January premium before knowing subsidy status?
Depends on your risk tolerance. If you have ongoing medical needs or prescriptions, maintain coverage even if it means paying the unsubsidized January rate. You can’t predict health emergencies. If you’re healthy and could handle a coverage gap, some people gamble on waiting to see if subsidies get extended in early January. But that’s risky—one accident or diagnosis and you’re paying full costs out of pocket while trying to get coverage reinstated.
The Bottom Line for Your 2026 Coverage
Doug Butchart said it plainly: “We can’t afford to not have insurance.” Millions of Americans are in exactly that position right now.
Enhanced subsidies made comprehensive health coverage accessible to families who’d been priced out of the market. Lose those subsidies and we return to pre-pandemic dynamics where people choose between premiums and groceries.
Congress might still act. The government shutdown might end tomorrow and subsidy extension could pass next week. But hoping for political breakthroughs isn’t a healthcare strategy.
Calculate your unsubsidized premium cost now. Research alternatives while you have time. Make enrollment decisions based on worst-case scenarios, not political optimism.
Because come January 1, your premium bill won’t care about Washington’s dysfunction. It’ll just arrive in your mailbox, regardless of whether Congress did its job.