According to a Gallup poll published this year, 62% of Americans believe it is the government’s responsibility to ensure that all Americans have healthcare coverage. Yet the potential expiration of the ACA’s Premium Tax Credit put millions’ health coverage in jeopardy. Here’s what you need to know about insurance for 2026 and beyond.
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The Big Beautiful Bill Has a Long Rollout
The US Congress passed and signed H.R. 1, the One Big Beautiful Bill Act, into law. This new federal law will cut $1 trillion in healthcare spending through 2034 and potentially result in up to 15 million more people living without health insurance by 2034. The estimated impact of the One Big Beautiful Bill Act, or the 2025 Budget Reconciliation Act, does not seem to reflect the desires of most US citizens, who believe that access to healthcare is a right that the government should provide.
How These Benefits Have Helped Black and Brown Communities
According to The Urban Institute, ‘Enrollment in the nongroup market in 2025, which includes the Marketplace, is estimated to be substantially higher across all racial and ethnic groups with enhanced PTCs relative to a scenario without enhanced PTCs. Enrollment increases among Black people (79 percent higher) and Hispanic people (61 percent higher) with enhanced PTCs are greater than enrollment increases among White people (42 percent higher).
A report by Oliver Wyman estimates that there may be a slow reversal of the gains we’ve made in insuring our families. The report predicts that up to 1.3 million Black enrollees and 2.4 million Hispanic/Latino enrollees will leave the ACA marketplace by 2027. A decline of 52% and 48% respectively, if the PTCs expire.
The Healthcare Marketplace Premiums Are Very Different for 2026
Earlier this month, millions of previously eligible people began applying for, or attempting to renew, their health insurance policies through the Affordable Care Act (ACA) Health Insurance Marketplace. They got sticker shock. As a result of federal budget cuts to healthcare spending approved by Congress, they are no longer eligible for the same low-cost coverage initially provided by legislation signed into law under the Obama administration.
Changes to the ACA Health Insurance Marketplace will be gradual, but being aware of how these policy shifts will impact you and your household could be critical in preserving your access to affordable healthcare in the future.
The Enhanced Premium Tax Credits (PTCs) Will Expire
Earlier laws provided additional PTCs, allowing for enhanced subsidies that made health insurance more affordable for many middle-income people and those above 400% of the federal poverty level. As a result, beginning with health insurance plans after 2025 (or in some cases after 2026), people who benefited from these enhanced subsidies could see a significant reduction in subsidy amounts, leading to higher out-of-pocket insurance premium costs and cost-sharing.
What this Could Look Like:
A 40-year-old woman with an annual income of $28,000 (138% of the federal poverty level for one person in many states) purchased a Silver-level insurance policy on the ACA marketplace that is heavily subsidized.
She pays $325 for the year (1% of her annual income) after the PTC is applied. According to an analysis by KFF (an independent source for health policy research, polling, and news), if the PTCs expire, her payment could rise to $ 1,562 (6% of her annual income).
If you are someone in the upper income range (for example, above 400% federal poverty level) and previously benefited from enhanced subsidies tailored for that income range, you are especially at risk of seeing a drop in support, making your coverage more expensive.
What this Could Look Like:
According to a KFF analysis, a 60-year-old couple earning about $85,000 annually (402% of the poverty level) could see an annual premium increase of over $22,600 in some states if the PTCs expire.
Changes to the Enrollment Process and Verification
The new law requires additional, more frequent verification of eligibility for lower-cost insurance premiums, such as income documentation or proof of citizenship.
What this Could Look Like: According to the Center on Budget and Policy Priorities, people who previously self-reported their income may now have to provide official documentation, such as pay stubs or employer letters. For someone with an income that can vary throughout the year, like seasonal workers, gig workers, or the self-employed, this could be particularly difficult. They’ll have to collect pay records, possibly explaining income swings.
It will also require anyone who receives health insurance through the ACA Marketplace to manually re-enroll each year to maintain their coverage. Unlike before, policyholders will not be automatically re-enrolled for the following calendar year.
It reduces or eliminates specific special enrollment periods for low-income enrollees or other people seeking to enroll outside the standard enrollment period. If your income changes or you have a significant life event and want to enroll outside the typical open enrollment window, you may have fewer opportunities to do so.
The standard open enrollment period for most states will be from November 1, 2025, to January 15, 2026.
State-specific Exceptions Reported by healthinsurance.org and KFF:
1. California: November 1 – January 31, 2026
2. New Jersey: November 1 – January 31, 2026
3. New York: November 1 – January 31, 2026
4. Rhode Island: November 1 – January 31, 2026
5. District of Columbia (D.C.): November 1 – January 31, 2026
6. Massachusetts: November 1 – January 23, 2026
7. Idaho: October 15 – December 15, 2025
8. Virginia: November 1 – January 30, 2026
More Restrictions on Eligibility for Immigrants
The law creates stricter eligibility requirements for certain lawfully present immigrants, causing previously eligible immigrants to lose their Medicaid/CHIP benefits and access to lower-cost Marketplace premiums.
What this Could Look Like: The rule removes DACA (Deferred Action for Childhood Arrivals) recipients from the definition of “lawfully present” for ACA eligibility. DACA recipients could lose eligibility for ACA Marketplace plans and the associated premium tax credits.
Changes to access affordable health insurance, for now, are inevitable. And because many of these shifts have been placed in the hands of your state lawmakers, the rules will vary. It is imperative that everyone, even those with employer-sponsored private insurance, carefully review their health insurance options at the very beginning of the open enrollment period. Do not wait. Plan for how you and your family will offset a potential increase in premium cost or changes to your eligibility. Do your research now. The ACA Health Insurance Marketplace is live at healthcare.gov, and the open enrollment period has begun.
For eligible US citizens who are struggling with the federal government’s decision to cut healthcare spending and create even more barriers to affordable, adequate healthcare, a simple yet powerful form of defense is to use your voice in upcoming elections. It was our elected officials who voted to pass the 2025 Budget Reconciliation Act that created the now-lawful reductions to healthcare subsidies that millions of us need.
Allow your voice to be heard among the collective. Your next opportunity to elect lawmakers who will work in the interest and desire of you and your community will be in early 2026.
In the words of one of our greatest civil rights leaders and creative minds, “The proof that one truly believes is in action.” -Bayard Rustin
