Representative Image. / NAPCA

Millions of Americans are confronting steep health insurance premium increases following the expiration of enhanced Affordable Care Act (ACA) tax credits, a change advocates say was entirely preventable and is already pushing people out of coverage.

Speaking at an Americans Community Media briefing, Anthony Wright, executive director of Families USA, said early data shows an average premium increase of more than $1,000 a year for the roughly 20 million people enrolled in ACA marketplaces, often far more.

“For many people, it’s not just hundreds, it’s thousands of dollars,” Wright said. “On average, it’s more than a doubling of their premiums, and in many cases it’s a tripling or a quadrupling, especially for low-income people who were paying $0, $5, or $10 a month and are now paying literally hundreds.”

Also read: Are we now cutting senior healthcare to the bone?

Older Americans are being hit especially hard. Wright cited cases of couples in their 50s and 60s now paying $10,000 to $15,000 a year for coverage. “That is a huge amount,” he said.

What Changed and Why It Matters

The enhanced tax credits, first expanded during the pandemic, capped how much households had to pay for health insurance as a percentage of income, roughly 8% for most people, with lower caps on a sliding scale for lower-income families. That guarantee expired in January.

Without it, premiums jumped sharply at the start of the year. Preliminary figures already show 1.4 million people losing coverage or downgrading their plans, a number Wright described as “just the beginning and the tip of the iceberg.”

Many enrollees were automatically renewed into higher-cost plans in January and may not yet realize they can’t afford the new premiums. As grace periods end in the coming months, Wright expects many more to fall off coverage.

“With open enrollment just ending, millions are now stuck with a massive health insurance premium spike and an awful choice,” he said. “Some have already dropped coverage. Others have moved to lower-tier plans with sky-high deductibles, paying more and getting less.”

Political Stalemate Despite Bipartisan Support

The premium hikes come despite broad bipartisan and public support for extending the tax credits. A majority in both the House and Senate have voted in favor of a three-year extension, including 17 House Republicans, an unprecedented level of bipartisan backing for ACA marketplace subsidies.

Yet congressional leadership has blocked passage, Wright said, while approving other tax extensions benefiting wealthy individuals and corporations. “These major premium increases were entirely preventable,” he said. “After an election focused on affordability, extending healthcare tax credits for working families should have been a no-brainer.”

Could Relief Still Come This Year?

If the Senate acts now, consumers would not necessarily have to wait until next November’s open enrollment, Wright said. Advocates are pushing for any compromise bill to include a special enrollment period so people who dropped coverage, or downgraded plans, could make changes.

Because subsidies are reconciled through the tax system, relief could also come retroactively. “For people who are still covered, this is a tax credit,” Wright said. “It could provide fiscal relief partway through the year or at tax time through a refund.”

Uneven Impact Across States

The fallout is expected to vary by state. In most of the country, the federal marketplace closed with the subsidy expiration fully in effect. States with their own exchanges—such as California—may continue releasing data as the impact becomes clearer.

Some states have taken limited action. New Mexico approved additional state-level subsidies, while California has funding to reduce deductibles and cost-sharing, though not enough to offset premium hikes. “What states can do is a fraction of what was in the federal deal,” Wright said. “The real solution is in the Senate.”

Immigrants and the Broader System at Risk

Wright also warned that hundreds of thousands of legal immigrants have lost coverage due to recent legislative and administrative changes, including the rollback of eligibility for people with DACA status and other protected categories.

As coverage erodes, the effects ripple outward. More uninsured patients mean higher uncompensated care for hospitals and clinics, threatening services and financial stability. At the same time, healthier people are more likely to drop coverage, leaving insurers with smaller, sicker risk pools, driving premiums even higher.

“This has a cascading impact on increased costs and decreased services for everybody,” Wright said, “not just those who are directly impacted.”

What Consumers Can Do Now

Advocates urge consumers to use official sites like Healthcare.gov or Covered California, shop and compare plans, and remember that baseline ACA subsidies still exist for people under 400% of the federal poverty level, about $60,000 for an individual or $125,000 for a family of four. Some may opt for bronze plans as a last-resort safety net, though those come with high deductibles.

“It’s not great that one of the options is to go uninsured or underinsured,” Wright said. “But that may be the reality for some folks.”

Open enrollment may have ended, he added, “but the fight for affordability has not.”