Overview

• An Urban Institute analysis funded by the Robert Wood Johnson Foundation projects $32.1 billion in provider revenue losses and $7.7 billion more in uncompensated care in 2026 if the enhanced ACA tax credits lapse.
• The enhanced premium tax credits end this year without congressional action, and Democrats want an extension in the stopgap spending bill as Republicans push to address the issue later, raising shutdown and timing risks before Nov. 1 open enrollment.
• KFF estimates consumers’ share of premiums would jump about 75% on average if the credits expire, while the Congressional Budget Office projects roughly 2 million people would lose coverage next year.
• Insurers are already pricing for a sicker risk pool, with KFF finding filings that add about 4 percentage points on average to account for adverse selection, and Pennsylvania regulators reporting proposed 2026 increases averaging 19% for individual plans.
• State marketplaces warn of early fallout, with Pennsylvania’s Pennie preparing higher-cost notices and estimating up to 150,000 residents could be priced out, and analyses pointing to especially large impacts in non‑Medicaid expansion states such as Florida, Georgia and Texas.