A key tax break that has helped millions obtain health insurance coverage under the Affordable Care Act since 2021 was not included in the One Big Beautiful Bill Act signed into law on July 4 by President Donald Trump. Now, medical professionals and health experts say premiums for people with ACA marketplace plans could rise sharply in 2026 without the enhanced premium tax credits most have become accustomed to.
“This legislation will do nothing to save costs in the long run; it will result in patients delaying care, illnesses going undetected, increased emergency room visits and, ultimately, in more patient deaths,” said Dr. Shannon Udovic-Constant, president of the California Medical Association.
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How the tax credits worked — and who they helped
The tax credit was used by more than 22 million Americans this year to lower monthly premiums from ACA plans. That’s about 92% of all marketplace enrollees, according to KFF, a health policy research and polling group. On average, it brought down the cost of coverage by $705, or 44%.
Those savings won’t last. If the expanded credits aren’t extended or replaced, monthly premiums are projected to jump by more than 75% next year. For many people, that kind of increase could mean losing health care coverage altogether.
What changed in the new law
Backed by President Donald Trump, the so-called “big, beautiful bill” cut more than $1 trillion from federal health care programs by 2034. According to the nonpartisan Congressional Budget Office, the measure and related policy changes could leave 16 million more people without health insurance by 2034 than if current policies remained in place. That includes an estimated 7.8 million people who could lose Medicaid coverage because of stricter eligibility rules and 3.1 million who might lose access to ACA marketplace plans.
Another 900,000 people could lose coverage because the legislation codified a Trump administration rule that limited who can sign up for ACA plans. On top of that, 4.2 million more people could lose coverage if the enhanced tax credits are allowed to expire.
While these are estimates, the CBO warns they signal a significant rise in the number of uninsured Americans over the next decade.
What did these premium tax credits do?
Premium tax credits were created in 2010 under the Affordable Care Act to help people pay for health insurance purchased through federal or state marketplaces. These credits lower the monthly cost of coverage based on income and family size.
People earning between 100% and 400% of the federal poverty level have traditionally qualified, but during the pandemic, the Biden administration expanded eligibility and the amount of aid.
That expanded coverage to more middle-income Americans and made premiums less expensive for lower-income families. For many, health policy experts say, the credits have meant the difference between being insured and going without health care.
