Tracking Emerging Public Health Challenges – November 2, 2025 – Obamacare
“On Saturday, Americans who don’t get health insurance through an employer, Medicare or Medicaid can start signing up for Obamacare coverage next year through the federal website, healthcare.gov, or one of the state-run marketplaces.
This year’s enrollment promises to be more confusing than those in the past. Congress is at a standoff over this year’s expiration of extra tax credits that had lowered the cost of coverage. The federal government has been shut down for more than a month, with the Republican-controlled House and Senate opposing the Democrats’ demand to extend the enhanced subsidies as a condition for reopening the government.
Most people now enrolled under the Affordable Care Act will still be eligible for some federal tax credits, but many will see their monthly costs soar without the extra help. Some may no longer qualify for a subsidy, and others will receive less assistance than they did this year.”
“The underlying cost of the plans is also increasing significantly. …” (6)
“Since its enactment, Obamacare has offered subsidies in the form of tax credits for health insurance premiums on plans purchased through the ACA’s exchanges based on enrollees’ income levels. During the COVID-19 pandemic, Congress enacted enhanced premium tax credits in 2021 that were extended by Democrats’ Inflation Reduction Act through the end of 2025 – with the policy now caught up in the shutdown debate.
About 24 million Americans are enrolled in health insurance plans and open enrollment for 2026 opens on Nov. 1, with insurers notifying members about increases in insurance premiums that are coming next year.
The Kaiser Family Foundation (KFF) estimates that health insurance premiums through the Obamacare exchanges are set to increase 26% on average in 2026. On state-operated ACA exchanges, the average benchmark (or second-lowest cost) silver tier premium that’s used to calculate the tax credit is set to rise 17%, whereas states using Healthcare.gov are rising 30% on average, according to KFF.”
“The group said that the increase reflects people with incomes below four times the federal poverty level receiving less financial assistance, and those with incomes above that threshold no longer being eligible for financial assistance and facing both higher premiums and the loss of the tax credit.” (1)
“Premiums for Affordable Care Act coverage will skyrocket 26%, on average, next year, according to a KFF analysis released Tuesday evening, just days before open enrollment starts on November 1.
The price hike is one of the largest jumps since Obamacare plans debuted more than a decade ago — and it doesn’t factor in the expiration of the enhanced premium subsidies.
“The monthly premium for the benchmark plan on healthcare.gov will soar 30%, on average, according to the KFF analysis, which is based on data from the Centers for Medicare and Medicaid Services. In states that run their own exchanges, the benchmark plan premium will rise by an average of 17%.
But that’s not all the bad news: The actual amount enrollees pay in 2026 will be far, far higher because the enhanced premium subsidies will disappear. Their monthly payments are expected to more than double, according to a separate analysis from KFF, a health policy research group.
Those window shopping on healthcare.gov will get a full sense of the sticker shock, many for the first time. The premiums on the site reflect the lapse of the enhanced assistance.
Still, most enrollees will be able to find 2026 plans on the federal exchange with premiums at or below $50 a month, after factoring in the original Obamacare subsidies, which are part of the 2010 health reform law and not expiring, according to a CMS fact sheet.
But the impact of the expiring enhanced assistance is clear: Nearly 60% of enrollees signing up for 2026 coverage can find plans in that price range, compared to 83% of consumers in 2025 plans.” (2)
“Residents of the 30 states that use the federally run HealthCare.gov will see an average 26 percent premium rise in 2026 for an average ACA plan, according to the analysis. Residents of the 20 states with their own exchanges will see an average 17 percent hike. These numbers include everyone on the exchanges.
However, that figure doesn’t reflect what a person who gets a subsidy might pay.
“There are two kinds of ACA subsidies. One kind was part of the Affordable Care Act first enacted in 2010. Layered on top are the enhanced subsidies created in the 2021 American Rescue Plan Act.
In that law, a Democratic Congress and then-President Joe Biden enhanced subsidies for everyone while lifting the income cap to qualify, 400 percent of the poverty level or $128,600 for a family of four, to offer subsidies to families earning more.
Right now, nearly all people on the exchanges get some form of federal subsidy that lowers insurance costs. The subsidy amount is based on household income, with poorer households required to pay a smaller percentage of their income for premiums compared to higher-income customers.
But the loss of the enhanced subsidies means the percentage of household income an ACA customer is responsible for paying increases. It’s likely to hit both high- and low-income earners the hardest.
For example, with the enhanced subsidies someone making $28,000 pays no more than $325, or 1.2 percent of their annual income, towards an average Obamacare plan. But if that subsidy goes away, that individual pays $1,562 annually, or 5.6 percent of their yearly earnings, or a 131 percent hike, according to a separate analysis from KFF.
Some very low-income customers who pay nothing in premiums now would have to pay 2 to 4 percent of their annual income, the requirement under the original ACA.” (4)
“Americans 60 years and older with an income of $65,000 will pay $920 more a month in 2026, according to estimates from the health research nonprofit KFF analyzed by The New York Times. That means monthly premiums will be $1,380 should the tax credits expire. If extended, monthly premiums in 2026 will be $460.
With the tax credits, Americans in this category can receive $866 in financial help, which covers 65 percent of monthly costs with the silver plan.
How much Americans will pay varies based on the counties they live in, their age and how much they receive as their income.
Americans aged 60 and older who make $65,000 and live in more rural states like Montana, Texas and New Mexico could see higher premiums. Some West Virginia residents will have to spend $1,544 more per month if the tax credits expire, compared with the $460 paid with the tax credits in effect, according to KFF’s online calculator.” (5)
“It was 2013, and conservative Republicans in the House and Senate pushed their leaders to block legislation to extend government spending unless it also repealed the Affordable Care Act. The result was a 16-day shutdown that produced no changes to the sweeping law.
While some of the characters are the same, the dynamic of today’s shutdown is the complete opposite. This time, it is Democrats using their leverage to try to fortify Obamacare by extending tax credits for rising premiums, while Republicans assail them for the hardships mounting from the cutoff of government services.
The 2013 case ended as a debacle for Republicans as they tried and failed to kill President Barack Obama’s signature legislative achievement while Democrats controlled the Senate. It was never going to happen.
Whether Democrats can be more successful this time around facing off against Republicans who have long targeted Obamacare remains to be seen. But trying to force policy changes through shutdown politics has not been fruitful in the past.” (3)
1.Obamacare prices are set to spike – here’s why, By Eric Revell, https://www.foxbusiness.com/economy/obamacare-prices-set-spike-heres-why
2.Obamacare enrollees get first look at 2026 prices as premiums soar, By Tami Luhby, https://www.cnn.com/2025/10/28/politics/obamacare-premiums-increase-2026-coverage
3. Shutdowns, Obamacare and the Risks of Bargaining for Policy Wins in a Crisis, By Carl Hulse, https://www.nytimes.com/2025/11/01/us/politics/shutdowns-obamacare-republicans-democrats.html?smid=nytcore-ios-share&referringSource=articleShare
4.Obamacare sticker shock is more shocking in some states than others, By Robert King, https://www.politico.com/news/2025/10/31/obamacare-sticker-shock-premium-hikes-00630754
5.This group will pay $920 more per month if ObamaCare subsidies expire, by Ryan Mancini, https://thehill.com/policy/healthcare/5581544-obamacare-premiums-increase-2026/
6.How to Shop for Obamacare When Subsidies Are in Limbo, By Reed Abelson and Margot Sanger-Katz, https://www.nytimes.com/2025/11/01/health/aca-obamacare-enrollment-health-insurance.html?smid=nytcore-ios-share&referringSource=articleShare
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai