The Kaiser Family Foundation estimates that the average person will pay 75% more for Obamacare plans next year. The ACA was already a bad deal, but it got worse for millions of Americans who will have to pay a greater share of their health plan premiums. Rising premiums are not just due to inflation, although that is significant. Rather, it is due to the Trump Administration’s decision not to extend the enhanced Marketplace subsidies to nonpoor Americans earning more than 400% of the federal poverty level.
In 2025 enrollment in ACA plans reached 24 million people. That is about double the number prior to when the enhanced subsidies went into effect during Covid. The Congressional Budget Office (CBO) estimates that 4.2 million people would drop coverage over the next decade if the subsidies are allowed to expire. In my opinion, the actual figure is more likely closer to 10 million, similar to enrollment prior to Covid. When other changes to the ACA are considered (e.g., shorter open enrollment, more restrictive special enrollment periods, pre-enrollment verifications, etc.) KFF Health News reports enrollment will fall precipitously causing the number of uninsured to be much higher:
The Congressional Budget Office estimates that 8.2 million people who get ACA insurance now will become uninsured over the next decade due to the expiration of the enhanced tax credits along with other changes that the Trump administration and Congress have made to the marketplaces through regulations and the One Big Beautiful Bill Act.
The ACA was designed to be a bad deal for most Americans. The uninsured population will rise as the number of people realize the ACA is a bad deal without wasteful taxpayer subsidies. The following is how KFF Health News explained the likely scenario:
People who are generally healthy might well decide that the higher premium is not worth it. They’ll go without health insurance and risk it.
If healthy people opt out, the insurance pool is left with those who cost insurance companies more — people who can’t go without health insurance because of chronic conditions or expensive medications. “That’s why insurance companies are going ahead and charging a higher premium, with the expectation that the market is going to get sicker next year,” explains Cox.
Obamacare is a bad value for all but the poorest Americans who qualify for subsidies and the sickest who see ACA plans as a discount on medical care. Anecdotes are not data, but I am one datapoint. I dropped my ACA plan after I lost my Obamacare subsidy due to changes in retirement planning. My premiums of around $9,000 a year for a bronze plan (with a similar deductible) was little more than a tax on healthy people. Nobody wants to get sick to benefit from health insurance, but my premiums were far higher than my risk. Expected costs are the sum of all probabilities, which are likely to amount to only a few hundred dollars a year in my case. Providing generous subsidies does not change what a bad value ACA plans represent. Subsidies merely shift the bad deal to taxpayers, rather than individuals. More from KFF Health News:
The Republican Study Committee’s 2025 fiscal budget said the enhanced subsidies “only perpetuate a never-ending cycle of rising premiums and federal bailouts — with taxpayers forced to foot the bill.” The chair of the Senate’s Health, Education, Labor, and Pensions Committee, Sen. Bill Cassidy, R-La., last year urged Congress to reject an extension, saying the subsidies “hide the unsustainable skyrocketing cost of Obamacare.”
The Affordable Care Act has nothing to do with making health care more affordable. Rather, Obamacare merely subsidizes overpriced health insurance with nothing in the way of cost control. The runaway cost of specialty drugs is mostly due to ACA’s ban on annual and lifetime limits on benefits, also resulting in sky-high premiums. The premise of the ACA is that people who are neither poor nor sick will maintain (bad) coverage due to fear of worst-case scenarios. Americans balked until subsidies made Obamacare’s value better. Perhaps fix Obamacare, rather than subsidize an inferior product. It was a missed opportunity in the One Big Beautiful Bill not to reform Obamacare to allow Americans access to health plans they prefer at prices they can afford to pay.
KFF Health News and NPR: ACA health insurance premiums will spike next year, unless Congress acts