Uncertainty persists as enrollment deadline looms

Congress is still deadlocked on a plan to extend Affordable Care Act enhanced premium subsidies, with less than one week to go before a key enrollment deadline — a limbo that experts say leaves many households with a difficult financial choice.

Roughly 22 million Americans receive the enhanced subsidies, which lower the cost of their ACA insurance premiums. They’ll expire at year’s end without congressional action. If that happens, the average recipient would see premiums for their insurance plan more than double in 2026, according to KFF, a nonpartisan health policy research group.

Meanwhile, households that rely on the ACA marketplace to buy health insurance — self-employed business owners, freelancers and early retirees, for example — must choose a health plan by Dec. 15 to ensure their coverage starts at the beginning of 2026.

The impending deadline amid uncertainty over the subsidies’ fate puts consumers in a tough position, experts said.

Some might decide to stomach higher premiums, while others are likely to switch to plans with lower up-front costs but skimpier coverage or perhaps drop their insurance altogether, experts said.

“People are going to have to make these massive financial decisions with a lot of uncertainty,” said Emma Wagner, a senior policy analyst at KFF who specializes on the Affordable Care Act.

“There are a lot of plans being discussed in Congress right now, but it’s still very unclear what’s going to happen and what’s going to take effect and when,” Wagner said.

Extending the subsidies was a key demand of Democrats during the recent government shutdown, the longest in history. Republicans had said they wouldn’t negotiate on the subsidies as part of legislation to end the shutdown.

Ultimately, a group of Democrats broke ranks and voted on an agreement to reopen the government. That agreement included a pledge from Republicans that the Senate would vote in December on a Democrat-drafted health-care bill.

Senate Minority Leader Chuck Schumer, D-N.Y., said Thursday that Democrats, the minority party, would force a vote this week on their plan for a three-year extension of the ACA subsidies. The measure is expected to fail due to a lack of Republican support.

There are likely to be other health-care bills floated this week, Chris Krueger, a strategist at Washington Research Group, which provides policy analysis for investors, wrote in a research note Monday.

Among them could be legislation from GOP moderates in the House and Senate, who would likely seek to extend the ACA subsidies but with additional restrictions tied to household income and an elimination of zero-dollar-premium plans, according to Krueger.

ACA-related legislation will likely pass eventually, “though it may take until late January 2026,” he wrote.

Extending the subsidies for one year would cost an estimated $30 billion in 2026, if there were no financial offsets, according to the Committee for a Responsible Federal Budget, a nonpartisan think tank.

Premium subsidies take the form of tax credits, which households can elect to receive in the form of lower monthly premiums or in a lump sum at tax time.

They’ve been in place since the early days of the Affordable Care Act, also known as Obamacare.

A Covid relief package passed in 2021, during the Biden administration, temporarily enhanced the subsidies, making the tax credits available to more households and increasing the amount. Congress extended the enhanced subsidies the following year, through 2025.

Those enhanced subsidies were available to households that earned more than 400% of the federal poverty level, unlike the original iteration of the premium tax credits. In 2025, that would equate to an income of more than $62,600 for a single person or $128,600 for a family of four, for example.

Under the enhanced subsidies, households’ out-of-pocket premiums were also capped at 8.5% of their income, down from 9.5%.

Those policies would revert to prior law if Congress doesn’t act.

Everybody who currently gets a premium tax credit would see their premiums jump, said KFF’s Wagner. However, certain groups would see a bigger spike than others, depending on factors like age, income and geography.

Those just over the 400% of poverty level threshold are especially vulnerable, since they’d lose access to premium tax credits altogether, experts said. In other words, they’d pay the full, unsubsidized insurance premium.

For example, a 60-year-old earning $64,000 wouldn’t get a tax credit, and would pay roughly $14,900 in annual health premiums, according to a KFF analysis. Meanwhile, the same person earning $62,000 would pay about $6,200, after getting a tax credit, KFF found.

The average subsidy recipient would see their annual premium payments jump by 114%, to $1,904 in 2026 from $888 in 2025, according to KFF.

About 23% of ACA marketplace enrollees in a new KFF survey already said it’s very difficult to afford out-of-pocket premiums.

“It’s a really staggering jump for a lot of people, and sometimes not possible to fit in a household budget,” Wagner said.

If their premium payments doubled, 32% of respondents said they would be very likely to look for a different health plan with lower premiums but higher deductibles and co-pays, according to KFF’s poll, which in November surveyed 1,350 U.S. adults ages 18-64 who are covered by an ACA marketplace plan.

About 25% said they would be very likely to go without insurance and 15% that they would look for a different job that provides health insurance, it found, which could prove difficult given a cooling labor market.

About 4.8 million more people will be uninsured in 2026 if the enhanced subsidies expire, according to the Urban Institute, a left-leaning think tank.

“We’ll have a ton of uninsured people,” said Carolyn McClanahan, a physician and certified financial planner based in Jacksonville, Florida. “It’ll be like the old days.”

Among those who are more likely to drop coverage are younger, relatively healthy people who think they may not need the insurance, experts said. That would put stress on the rest of the health-care system if older, sicker enrollees remained behind, forcing insurers to raise costs further, they said.

Forgoing insurance also poses a financial risk to households.

“People don’t realize a broken ankle can easily cost $20,000,” said McClanahan, founder of Life Planning Partners and a member of CNBC’s Financial Advisor Council. “Even minor things can end up costing a heck of a lot of money.”

McClanahan recommends that consumers plan for current law — meaning, they should expect an end to the enhanced subsidies — when picking their insurance for 2026.

“You plan for what is, and not what you hope to be,” she said. “That way, you are at least doing something.”

She also cautioned against automatically seeking out a health plan with the cheapest monthly premiums.

For example, such a plan may require consumers to pay a high deductible before the insurance ever covers medical care. A plan with only slightly higher premiums may be the better option, she said. For example, it might still carry a high deductible but could also carry a co-pay that enables the insured to see a doctor for, say, $40, without first hitting the full deductible, McClanahan said.

Additionally, cheap plans tend to have “skinnier networks” for doctors, she said.

There are other details to pay attention to, too, such as whether the plan is an HMO or PPO, for example, she said. HMO plans are generally cheaper, but consumers generally need a referral from a primary care doctor to see specialists, which generally isn’t true for PPO plans.