In 2025, more than 22 million Americans got their health insurance through the Affordable Care Act (ACA). Because Congress did not extend the enhanced premium tax credits that had been in place since 2021, millions of ACA enrollees have lost coverage, and those who remain are now paying higher premiums and often have less generous plans.
In the average congressional district, an estimated 55,800 people selected ACA health insurance plans during 2025’s open enrollment period, and enrollment averaged 50,700 people over the course of the year. This year, ACA coverage is plummeting because families cannot afford the higher premiums. In the average district, enrollment is projected to fall by 11,900 people (23%)from 2025 average enrollment levels.
Enrollees in most states must now pay the full cost of the expired enhanced tax credits. Holding the 2025 enrollee population and plan mix constant, the estimated average annual net premium across the 41states and the District of Columbia that do not provide state-funded assistance is about $890 higher in 2026 – a 78% increase.
Nine states – California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington – are providing additional state support to enrollees whose costs have increased due to the expiration of the federal enhanced premium tax credits. Only in New Mexico, however, do the state subsidies fully replace the expired federal tax credits for all residents.
Higher premiums are pushing enrollees into plans with higher deductibles. About 2 million more ACA enrollees selected bronze plans in 2026 than in 2025. In the districts where deductible information is available, a single enrollee who switches from a silver plan to a bronze plan faces an average deductible increase of $2,161. For family coverage, the average deductible increase is $4,323.
Across the country, the largest premium increases are falling on households that benefited the most from the enhanced tax credits. For benchmark silver plans in states that do not provide supplemental support:
● A couple, both age 60, with a household income of $85,000 has seen their premiums increase by $22,700 this year – to over four times what they paid last year.
● A family with two adults, both age 40, two children, and a household income of$129,000 has seen their premiums increase by more than $12,500 this year – to more than double what they paid last year.
● A single-parent household with one adult age 35, one child, and a household income of $32,000 has seen their premiums increase by more than $1,300 this year – to more than 100 times what they paid last year.
Note: Estimates published on July 22, 2026. Estimates for states with redrawn congressional districts are available at this link.
