NEW YORK CITY, New York: Millions of Americans are beginning 2026 facing sharply higher health insurance bills after enhanced Affordable Care Act subsidies expired, locking in premium increases that could force some households to drop coverage altogether.

The tax credits, first introduced during the COVID-19 pandemic and later extended by Democrats, had lowered insurance costs for most people who buy coverage on the Affordable Care Act marketplaces. Their expiration comes after months of political deadlock in Washington, despite warnings from both parties that the issue could carry significant electoral consequences.

Democrats pushed unsuccessfully to extend the subsidies, even triggering a 43-day government shutdown over the issue. Some moderate Republicans urged action, while President Donald Trump floated — then abandoned — a potential compromise after opposition from conservative allies. With no agreement reached before the deadline, the credits expired at the start of the new year.

A House vote expected later in January could reopen the debate, but there is no guarantee that lawmakers will succeed in restoring the subsidies.

The lapse affects millions of Americans who do not receive health insurance through an employer and are ineligible for Medicaid or Medicare — including self-employed workers, small business owners, farmers, and ranchers. The timing also coincides with a midterm election year in which affordability, particularly healthcare costs, ranks among voters' top concerns.

"It really bothers me that the middle class has moved from a squeeze to a full suffocation, and they continue just to pile on and leave it up to us," said Katelin Provost, a 37-year-old single mother whose premiums are set to soar. "I'm incredibly disappointed that there hasn't been more action."

Costs Jump Sharply for Many Households

The expanded subsidies, introduced in 2021, allowed some lower-income enrollees to obtain coverage with no monthly premium, capped costs for higher earners at 8.5 percent of income, and broadened eligibility for middle-class households. Democrats later extended the program through the end of 2025.

With those credits gone, the impact is substantial. On average, more than 20 million subsidized Affordable Care Act enrollees are seeing premium increases of 114 percent in 2026, according to an analysis by KFF.

The higher premiums come amid broader increases in U.S. healthcare costs, which are also pushing up deductibles and other out-of-pocket expenses.

Some enrollees are absorbing the added burden. Stan Clawson, a 49-year-old freelance filmmaker and adjunct professor in Salt Lake City, said his monthly premium will rise from just under US$350 to nearly $500. Clawson, who lives with paralysis from a spinal cord injury, said the increase is painful but unavoidable.

Others face far steeper hikes. The Provost said her premium is jumping from $85 a month to nearly $750.

Enrollment Fallout Still Uncertain

Health policy experts warn that higher premiums could lead many people — particularly younger and healthier enrollees — to abandon coverage, raising costs further for those who remain insured.

An analysis by the Urban Institute and the Commonwealth Fund last September projected that about 4.8 million Americans could lose coverage in 2026 due to the expiration of subsidies.

However, enrollment effects remain uncertain, as the deadline to select or change plans runs through Jan. 15 in most states.

Provost said she is hoping Congress revives the subsidies early this year. If not, she plans to drop her own coverage and keep insurance only for her four-year-old daughter.

Political Stalemate Continues

In December, the Senate rejected competing partisan proposals — a Democratic plan to extend the subsidies for three years and a Republican alternative centered on health savings accounts. In the House, four centrist Republicans joined Democrats to push for a vote on a three-year extension, though prospects for passage remain unclear.

For many Americans, the impasse feels detached from everyday realities.

"Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it," said Chad Bruns, a 58-year-old Affordable Care Act enrollee in Wisconsin. "They need to get to the root cause, and no political party ever does that."