In recent years, the healthcare system in the United States has undergone significant changes, making Affordable Care Act (ACA) plans, known as Obamacare, more accessible to millions of Americans. But this reality may be about to change.
With the possible expiration of expanded subsidies in 2025, experts warn of a considerable increase in health plan costs and even the loss of coverage for millions of people. What is at stake? How could this affect those who depend on the system?
Today, I bring an overview of the main anticipated changes and their potential impact.
What Are ACA Subsidies and Why Are They Important?
ACA subsidies were created to help low- and middle-income individuals pay for government-offered health plans. Before the pandemic, many families still struggled to afford these costs, but in 2021, an emergency package temporarily increased subsidies. The more generous subsidies increased financial assistance for low-income individuals who were already eligible under the ACA and extended help to those with higher incomes (above $60,240 for individual coverage in 2025) who previously did not qualify.
With this expansion, many people began paying significantly lower amounts for health plans. In some cases, monthly premiums were reduced to zero for low-income individuals. Now, this measure is set to expire. If Congress does not renew the initiative, costs could rise again in 2026, making coverage unaffordable for millions of Americans. Almost all marketplace enrollees would see “steep” premium increases next year, according to a KFF analysis.
What Could Happen in 2026?
Experts point to three possible scenarios for the coming years:
Expanded Subsidies Are Renewed
This would be the ideal scenario for ACA beneficiaries, ensuring that plans remain affordable. However, there is strong political resistance to approving this measure.
Subsidies Return to the Pre-2021 Model
This would mean a significant cost increase for millions of insured individuals. Studies indicate that some families could see their monthly premiums double.
Broader Cuts to the Program
In addition to the end of subsidies, other changes are being discussed, such as reducing the enrollment period and eliminating flexibilities created during the pandemic.
Who Will Be Most Affected?
The impact of these changes may be felt unequally. Among the most vulnerable groups are:
- Self-employed workers and freelancers who rely on the ACA for health insurance.
- Low-income individuals who may no longer afford coverage without subsidies.
- DACA (“Dreamers”) recipients, who recently gained access to ACA coverage but could lose this right if changes are approved. (DACA stands for Deferred Action for Childhood Arrivals, a program introduced in 2012 that applies to certain undocumented immigrants brought to the U.S. as children.)
- Older adults who do not yet qualify for Medicare but use ACA as their primary coverage option.
According to the Congressional Budget Office (CBO), at least 2.2 million Americans could lose their health plans if subsidies are not renewed.
The Risk of Reducing the Enrollment Period
Another change that could make healthcare access more difficult is the proposal to shorten the open enrollment period. Currently, Americans can enroll in ACA plans from November to January. Under the new proposal, the deadline could be shortened to December, reducing the time for consumers to find a suitable plan.
Additionally, special enrollment periods—which allow low-income individuals (annual income up to $22,590 for individual coverage in 2025) to enroll at any time of the year—could be eliminated. This means that those who miss the deadline would have to wait until the following year to obtain coverage.
A rule proposed by the Trump administration would abolish this option, which has been available in most states. According to the agency, this change is due to concerns about “unauthorized” enrollments, including cases where dishonest brokers enroll people in plans without their knowledge.
What Is Being Done to Prevent These Changes?
Consumer advocacy organizations, economists, and healthcare professionals are pressuring Congress to find a solution that avoids negative impacts for millions of people. Progressive groups argue that subsidies should be maintained and even expanded, while more conservative lawmakers question the fiscal impact of the measure.
What Could Happen in the Coming Months?
The debate over subsidy renewal and other ACA changes is expected to intensify in the coming months. Meanwhile, experts recommend that Obamacare beneficiaries stay informed about Congressional decisions and evaluate their plan options for the coming years.
If these changes take effect, millions of Americans may have to prepare for higher costs or even seek alternatives to secure medical coverage. The future of the healthcare system remains uncertain, but one thing is clear: the impact of these decisions will be felt by millions of people.
