As the federal government shutdown continues, the potential expiration of enhanced ACA subsidies is already reshaping the coverage landscape, with 2026 plan prices increasing in several states and payer participation shrinking in some markets, according to The New York Times.
Six things to know:
1. ACA plan prices are climbing in multiple states With open enrollment set to begin Nov. 1, several state-run marketplaces — including California, New York, Maryland, Idaho and Nevada — have posted 2026 ACA premiums, according to the report. Early filings show sharp premium increases in many markets, giving consumers and providers a preview of potential cost burdens if federal subsidies are not renewed. Without subsidy renewal, consumers face significant out-of-pocket costs and fewer plan options, as some insurers exit key markets.
2. ACA premiums will spike without intervention. KFF estimates average premiums for subsidized enrollees could increase 93% without an extension. Payers are already requesting double-digit rate hikes, and as coverage affordability declines, hospitals may see payer mix shift away from commercial and subsidized exchange plans toward Medicaid, charity care, or uninsured volumes.
3. Millions of Americans stand to lose coverage. The Urban Institute projects 4.8 million Americans would become uninsured if ACA subsidies lapse. More uninsured patients typically mean more delayed care and higher uncompensated hospital usage, particularly in safety-net, rural and high-Medicaid hospitals. Mississippi would be the hardest hit, with 99% of ACA enrollees currently receiving enhanced tax credits.
4. Most ACA subsidy recipients reside in GOP districts. Many hospitals serving GOP-controlled districts would see a direct financial fallout from a lapse. Loss of coverage would increase avoidable emergency department use, drive up healthcare costs and stretch thin already-burdened systems — particularly in rural and underserved areas where exchange plans represent a growing share of revenue.
5. GOP pollster warns of a “political catastrophe”: John McLaughlin, longtime pollster for President Donald Trump, has warned Republican lawmakers that failing to extend the ACA’s enhanced subsidies could spark significant voter backlash — especially among patients facing steep premium increases or coverage loss, according to the Times. Fourteen 14 GOP representatives from swing districts are backing an ACA subsidy extension, indicating cross-party recognition of how coverage losses could affect constituents — and by extension, local hospitals.
6. Democrats have drawn a red line. Senate Minority Leader Chuck Schumer, D-N.Y., has repeatedly stated Democrats will not support a funding bill without extending the ACA premium tax credits, making it a make-or-break issue in the shutdown talks.
