A critical tax credit available to many Affordable Care Act (ACA) Marketplace enrollees is set to expire at the end of the year. The change will cause health insurance premiums to dramatically increase, and Americans are aghast at just how much more it will cost.
Under the original ACA, enrollees earning between 100% and 400% of the federal poverty level were eligible to receive premium tax credits designed to make health insurance more affordable. The American Rescue Plan Act, signed into law by President Joe Biden on March 11, 2021, established enhanced premium tax credits that expanded eligibility and increased the subsidy amount.
After enhanced premium tax credits were introduced, enrollment surged from 11.4 million people in 2020 to 24.3 million people in 2025, according to health policy research firm KFF.
Originally set to expire in 2022, the enhanced tax credits were extended under the Inflation Reduction Act. Now, unless Congress once again extends the credits, subsidized enrollees on average can expect a whopping 114% increase in health insurance premiums, with costs varying depending on income and family arrangements.
Sticker Shock: Health Insurance Premiums
The ACA marketplace recently released its 2026 health insurance plans and prices, leaving customers stunned. According to KFF, premium payments for subsidized enrollees will “more than double,” jumping on average from $888 in 2025 to $1,904 in 2026.
For many of the 22 million Americans who rely on the marketplace for health insurance, those rising costs could mean choosing between coverage and survival. A viral video with more than 3.3 million views on X captures this very struggle, showing a woman torn between keeping her health insurance or her home:
“It’s really unfair that I have to choose either having healthcare or a roof over my head. I got a letter today from [Blue Cross Blue Shield] and my monthly premiums went up to $2,627 a month. If I choose health insurance, I lose my house. If I choose my house, I lose my health insurance.
…
Either way, I’m kind of screwed. And I’m not even mad. I just don’t care anymore, I guess. There’s just no win.”
She’s not alone. One Alabama resident wrote on X: “I left my job last month and needed to buy insurance on the marketplace. I found a plan at $114 a month. I have to re-enroll at the start of the calendar year and the same plan will now cost me $569 a month. The system is broken.”
Backup Plan
With marketplace premiums skyrocketing, many Americans are exploring alternatives to traditional health insurance. While there’s no true substitute, those who opt out of insurance entirely may turn to cash-pay arrangements and crowdfunding tools.
One such option, CrowdHealth, describes itself as a “platform & community that empowers you with a crowdfunding tool and a wealth of resources to efficiently manage your health care costs.”
Another alternative, GoFundMe, has already become a lifeline for those with expensive medical bills. A study published in the Journal of Philanthropy and Marketing found that medical-related fundraising campaigns on the platform skyrocketed from roughly 8,000 in 2011 to about 200,000 per year by 2020 in the United States alone.
Additionally, the Consumer Financial Protection Bureau provides information on financial assistance programs, otherwise known as “charity care,” to help pay for medical bills. “These programs may help patients who do not have insurance and patients who have insurance but are underinsured. These programs may be provided by your medical care provider and your state. Additionally, there may be non-profit organizations or advocacy groups that can help you,” the bureau’s website states.
Experts warn that, as more Americans abandon traditional insurance, those who remain will pay the price.
“The expiration of these federal benefits increases premium costs for individuals and families and is expected to result in more people deciding to forego insurance coverage. This will shrink the population with coverage and worsen the risk pool requiring higher premiums for the remaining members,” Blue Cross Blue Shield of Vermont warned.
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