The expiration of enhanced subsidies for the Affordable Care Act (ACA) on January 1 is expected to have significant consequences for rural hospitals and Americans who rely on them. The subsidies, which were introduced in 2021 to make health insurance more affordable during the COVID-19 pandemic, are set to expire, and Congress has yet to extend them. As a result, health care costs are expected to rise, and many Americans may opt for cheaper insurance with higher deductibles or drop their coverage altogether.
According to an analysis by the Kaiser Family Foundation (KFF), ACA premiums for over 24 million Americans are predicted to double starting in 2026, and 4.8 million Americans could lose coverage. This could have devastating consequences for rural hospitals, which already operate on thin margins. If a large portion of their patient population loses insurance, hospitals may be forced to close, leaving communities without access to essential health care services.
The loss of subsidies will not only affect consumers but also rural hospitals, which may struggle to stay afloat. Even if hospitals don’t close, they may be forced to charge higher prices to offset the costs, making health care even more unaffordable for those who need it. The USDA Economic Research Service reports that 146 rural hospitals have already closed or been converted to non-acute health care clinics between 2005 and 2023.
Health care policy experts are concerned about the impact on Americans with chronic health conditions who cannot afford to drop their insurance. They may be forced to pay thousands of dollars more per month for coverage, which could lead to delayed or foregone care. The consequences of the subsidy expiration will be far-reaching, affecting not only those who lose coverage but also those who continue to receive care from struggling hospitals.
The situation is further complicated by significant cuts to Medicaid and Medicare reimbursements under President Donald Trump’s One Big Beautiful Bill Act. These cuts could exacerbate the financial struggles of rural hospitals, leading to reduced services, staff layoffs, and decreased investment in quality care. As one expert noted, “If a hospital closes, it obviously doesn’t just affect the people who are coming in without insurance, but it affects everyone who is receiving care from that hospital.” The expiration of the ACA subsidies is a critical issue that requires immediate attention from policymakers to prevent a health care crisis in rural America.