Overview
- Congress reopened the government without extending the pandemic-era ACA premium tax credits, which are set to end on December 31 as open enrollment proceeds.
- Senate leaders promised a floor vote in December, while House leaders have not committed to consider an extension, leaving enrollees and insurers in limbo.
- Republicans are debating replacements such as direct cash payments and pre-funded HSA- or FSA-style accounts, reflecting President Donald Trump’s push, as some conservative analysts caution such cash could increase spending through a woodwork effect.
- KFF projects average out-of-pocket premiums would rise roughly 75% if the enhancements lapse, and CBO estimates 4.2 million more people would be uninsured over the next decade.
- Insurers and state exchanges have priced plans for a possible lapse and warn healthier consumers may drop coverage, with residents in states like Florida and Ohio already reporting sharp projected increases for 2026.