NEW YORK/WASHINGTON: As the main enrollment window for subsidized U.S. health insurance plans closes, millions of Americans are heading into 2026 facing sharply higher premiums or the prospect of scaling back or losing coverage, with Congress still deadlocked over restoring pandemic-era aid.

Open enrollment for most federally subsidized plans under the Affordable Care Act, often called Obamacare, ended on January 15. The deadline comes amid uncertainty over whether lawmakers will reinstate expanded tax credits introduced during the COVID-19 pandemic, which significantly lowered costs for consumers.

In 2025, about 24 million people were enrolled in the plans created by former President Barack Obama, with roughly 22 million receiving subsidies. Without renewed federal support, average annual premiums are expected to more than double, rising to US$1,904 in 2026 from $888 in 2025, according to KFF.

Those increases are likely to force difficult choices for many households, said Cynthia Cox, a senior vice president at KFF.

"Those cost hikes mean some buyers will need to make trade-offs in their household budget, settling for a lower level of coverage, or dropping coverage altogether," she said.

As of January 12, 22.8 million people had signed up for plans through Healthcare.gov and state-run marketplaces in 20 states, most of which are led by Democrats. In eight states and Washington, D.C., enrollment periods have been extended.

States Find Funds to Help

Several states — including Massachusetts, California, Colorado, Connecticut, Maryland, and New Mexico — have pledged funding to help lower- and middle-income residents manage higher costs.

But Christina Cousart, a director at the National Academy for State Health Policy, said state-level assistance is unlikely to fully offset rising premiums, given the size of the funding gap and mounting costs tied to Medicaid, the government insurance program for lower-income Americans.

Pennsylvania, for example, has considered freeing up $50 million, far less than the $600 million its residents previously received through federal subsidies.

"The levels we had talked about are a drop in the bucket compared to the federal amount of money," said Devon Trolley, executive director of Pennsylvania's marketplace.

Republican-led states have not announced similar relief measures, despite the fact that their residents benefited disproportionately from COVID-era subsidies because those states did not expand Medicaid under the ACA.

Eight of the 10 states with the highest share of residents receiving ACA subsidies — Florida, Georgia, Texas, Mississippi, South Carolina, Alabama, Tennessee, and North Carolina — are Republican-controlled states that voted for President Donald Trump.

Uncertainty About a Deal

Congress could still reinstate the expanded subsidies retroactively.

Republican U.S. Senator Bernie Moreno of Ohio, part of a bipartisan group negotiating a potential extension, said a deal must be reached by the end of January.

Democratic U.S. Senator Tim Kaine, also involved in the talks, told Reuters the agreement has a "fighting chance," but disagreements over abortion policy have slowed negotiations.

Abortion coverage remains a central sticking point, with lawmakers split on whether ACA plans fully comply with the Hyde Amendment, which bars federal funding for abortion services.

Trump said this week he would unveil a healthcare affordability framework later this week, adding to expectations that healthcare costs will be a major election issue this year.

Enrollment Could Fall Further

The government's 2026 enrollment figures include people automatically renewed for coverage, many of whom may later drop out if they fail to pay premiums, experts said.

Michele Eberle, executive director of the Maryland Health Benefit Exchange, noted that insurers cannot cancel coverage for non-payment for 90 days.

"We won't know if they're truly terminated for non-payment of premiums until the beginning of April," she said.

If Congress extends the subsidies and opens a special enrollment period, insurers could benefit as lower costs attract healthier enrollees, said Marty Anderson, chief strategy and business development officer at Group Health Cooperative of South Central Wisconsin.

Even a delayed extension would help stabilize premiums in 2027 by broadening the risk pool, Anderson said.