The cost of health insurance in the US is expected to increase significantly for millions of Americans, posing a major challenge for President Donald Trump. The enhanced tax credits introduced in 2021 under President Joe Biden, which reduced the cost of Affordable Care Act (ACA) premiums for roughly 24 million people, are set to expire on December 31. If the credits are not extended, the average premium is expected to more than double, with a family of four with a household income of $75,000 facing an annual premium increase from $2,498 to $5,865.
This increase would leave many Americans facing the prospect of giving up their health insurance altogether. Lori Hunt, a breast cancer survivor from Iowa, is one such individual who would be unable to afford the $650 monthly increase in her health insurance premium. She would have to switch to a plan with less coverage or higher deductibles, or go without health insurance until she finds a job that provides it.
The Senate is set to vote on extending the ACA subsidies, which could provide relief to individuals like Hunt. However, Trump has floated his own idea to tackle rising healthcare premiums, which would deal a crippling blow to Obamacare. Trump’s plan would shift government-funded subsidies away from health insurance corporations and instead provide them directly to individuals, allowing them to purchase their own health care. This plan has been met with criticism, with advocacy groups arguing that it would sabotage the ACA and leave Americans without the coverage they need.
The debate over the ACA subsidies comes at a time when affordability is a top political concern in the US. Recent elections and polls have shown that voters are prioritizing affordability, particularly when it comes to healthcare. The Urban Institute estimates that 4.8 million more people will be uninsured in 2026 if the enhanced tax credits are not extended, while the Congressional Budget Office puts the figure at 4.2 million.
The expiration of the ACA subsidies would undermine the entire premise of the ACA, which guarantees coverage for individuals with pre-existing conditions and provides essential health benefits like hospitalization and maternity care. Trump’s plan has been criticized for pushing people into “junk insurance plans” that do not provide adequate coverage. The fate of the ACA subsidies will be decided in the coming weeks, and it remains to be seen whether Congress will extend the subsidies or allow them to expire, leaving millions of Americans without affordable health insurance.