Millions of Americans may face higher health insurance costs in 2026 following changes to the Affordable Care Act included in the One Big Beautiful Bill Act (OBBA), which was signed into law on July 4, 2025. The bill did not include an extension of the enhanced Premium Tax Credits (PTCs), which would have allowed them to expire at the end of 2025, making it harder for many marketplace enrollees to afford health insurance under the Affordable Care Act.
Now that some of those subsidies have expired and the cost of living has increased, many households are facing difficult financial choices: paying for everyday essentials like gas and food or funding their family's health insurance. For many households facing rising grocery, housing, and fuel costs, health insurance coverage may become harder to afford. Keep reading to find out why it's happening and what options may still be available if you’re struggling to afford coverage.
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Under the 2025 healthcare policy changes backed by Republicans, several Affordable Care Act provisions were scaled back, according to a May 2026 analysis from KFF and other health policy experts. The changes included new work requirements for some Medicaid expansion recipients, while the enhanced ACA subsidies that lowered marketplace costs expired at the end of 2025. These changes are most likely to affect ACA marketplace enrollees, Medicaid recipients, and those near the subsidy income thresholds.
While some things have already begun—like the expiration of the enhanced Premium Tax Credits (PTCs), which expired on Dec. 31, 2025—some have yet to happen, like:
Eligibility restrictions for certain immigrant groups beginning Oct. 1, 2026, according to the National Immigration Law CenterMore frequent Medicaid eligibility checks beginning Dec. 31, 2026Related: If You Want To Save Money, You Might Want To Start Carrying Cash
These changes could mean millions of people lose coverage, according to estimates from the health policy research organization KFF, with millions more expected to drop their coverage in the coming years. A May 19, 2026, report from KFF estimates ACA marketplace enrollment could decline by nearly 5 million people in 2026, a more than 21 percent drop from the prior year.
And while they say the losses from Medicaid expansion work requirements are harder to predict, since implementation timelines are still being determined, KFF predictions say that Medicaid enrollment is expected to drop by 7.5 million over the next few years.
What Happens if You Can’t Afford Health Insurance
According to Reuters, total premium costs for those enrolled in subsidized plans are expected to average $1,904 in 2026, up from $888 in 2025. If you're among those who can't really afford to pay the full price of a health insurance policy through the marketplace, you have a few options. First, look at the plans available on your state's marketplace to see if there are more affordable options. While these are typically still part of the ACA, you may find an agreeable option there.
There are different tiers of plans, and if you are relatively healthy, you may be able to sign up for an emergency plan that acts as "catastrophic" coverage in the event you are injured or get sick and need hospitalization. Additionally, short-term health plans can be available, according to Cigna, which can help you obtain temporary coverage while you are between health plans or between enrollment periods. Just note that these types of plans can have different coverage limits, so it's important to read the "exclusions and limitations" on the plan before signing up for one to make sure it will meet your needs.
If that doesn't work, you may want to shop for a policy off the marketplace by researching different insurance companies directly. These insurers may have policies that differ from those they present on their websites, and they may offer options that better suit your financial situation.
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Lastly, you can apply for financial aid through your state or the federal government. While there have been many cuts to aid programs over the years, some remain in place for those whose income falls below the poverty line. Consider researching the options available to you in your state to see if you qualify. For example, in the Commonwealth of Pennsylvania, your income would have to fall within 133 percent of the federal poverty level (FPL), according to Medicaid.gov.
Healthcare experts generally recommend maintaining some form of coverage whenever possible, since unexpected medical emergencies can quickly become financially overwhelming.
Disclaimer: This article is for informational purposes only and does not constitute financial advice.
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