No Good News about the Individual Health Insurance Marketplace in 2026

One of the tragedies of healthcare policy in our country is the whipsawing of millions of people gaining access to coverage and then losing it.  That is what is set to happen in the individual market in 2026 because enhanced premium tax credits will likely not be renewed, and many people in relatively good health will forgo health insurance if their subsidy is substantially reduced.

Some are blaming the One Big Beautiful Bill Act legislation, but that legislation addresses Medicaid, not the individual market.  It was the American Rescue Act, followed by the Inflation Reduction Act passed under the Biden administration, that created enhanced subsidies for the individual market, which are set to expire at the end of the year. The Affordable Care Act always provided subsidies for those with incomes under 400% of the Federal Poverty Level. The American Rescue Act and then the Inflation Reduction Act provided enhanced subsidies to all those eligible.  In addition, premium assistance was extended to those making above 400% of the FPL, capping premiums for a benchmark silver plan to no more than 8.5% of household income.  These subsidies are set to expire.

Let’s review the enrollment history.  According to the Kaiser Family Foundation reports, in 2014, the first year the Affordable Care Act reforms took effect, about 8 million people enrolled in the individual market.  By 2016, the numbers were up to 12 million.  During the first Trump Presidency, those numbers dipped but held fairly steady.  Under the Biden administration, enrollment more than doubled to 25 million.  

Premiums will increase substantially in 2026.  Medical inflation combined with more healthy people foregoing insurance will result in fewer people to spread increased costs over.  Open enrollment for 2026 begins on November 1st.  Everyone should carefully review options.