At the core of the government shutdown is a debate about the extension of health insurance subsidies under the Affordable Care Act, first implemented in 2021.The shutdown began at the start of the new fiscal year, Oct. 1. In budget negotiations, Democrats were aiming to extend the expanded subsidies, set to expire at the end of 2025, while Republicans have emphasized reopening the government before beginning health care talks.If these tax credits expire, it’s estimated that the more than 24 million people enrolled in marketplace plans will pay twice as much out of pocket, according to Jeanne Lambrew, director of health care reform at the Century Foundation. KFF estimated the average premium payment would increase 114% from $888 to $1,904 without expanded subsidies.Plus, the impacts could be felt even sooner as open enrollment is set to begin Nov. 1 for people to select health insurance coverage for 2026. The ACA, sometimes referred to as "Obamacare," was designed to make health care affordable and accessible via marketplaces, Lambrew said, who also worked on drafting and implementing the ACA during the Obama administration.The goal of the marketplaces were to fill in the gaps, according to Lambrew. It is for people who make too much to qualify for Medicaid, but also for people who don't have access to affordable insurance through their work.Enrollment in the ACA has increased since its passage in 2014, but really climbed in the last five years. From 2020 to 2025, enrollment more than doubled as a result of expanded tax credits passed in the American Rescue Plan Act in 2021, which increased the subsidies and lifted a cap that disqualified people making four times the poverty level or more from being eligible for the subsidies. Under 2025 guidelines for the 48 contiguous states and Washington, D.C., the federal poverty level is $15,650 for a one-person household. At 400%, it's $62,600.Nearly all states saw an increase in enrollment under the ACA from 2020 to 2025, with 20 states more than doubling in enrollment.Six states more than tripled in the number of people enrolled under the ACA — Texas, Mississippi, West Virginia, Louisiana, Georgia and Tennessee.States that President Donald Trump won in the 2024 election have the majority of enrollees, according to an analysis from KFF.“We know that three out of four enrollees in the health insurance marketplace live in states that voted for President Trump in 2024,” Lambrew said. “So this is not a partisan issue, it's a nationwide issue, and it affects people in different ways, but the overall effect is significant.”Who is impacted?The subsidies, also called tax credits, at the center of the shutdown are utilized by about 92% of people enrolled in marketplace plans under the ACA, according to data from the Centers for Medicare & Medicaid Services.These expanded credits allow households of different sizes and income levels to be capped with maximum out-of-pocket costs.Once the expanded tax credits expire at the end of this year, the out-of-pocket maximums will increase across the board, and people making above four times the poverty level will become ineligible for any tax credits.More than 6.7% of those who were enrolled in ACA plans earned more than 400% of the federal poverty level, accounting for 1.6 million people. Once the subsidies expire, these enrollees would no longer qualify for the subsidies under the ACA.Also heavily impacted are people approaching retirement age. The age group with the highest enrollment in marketplace plans is ages 55 to 64, data shows. KFF estimated in March that about half the enrollees who would lose the tax credit upon expiration are between 50 and 64.As people grow closer to retirement age, they may not rely as much on employer-provided insurance before turning 65 and qualifying for Medicaid, according to Lambrew.How much would premiums change?KFF has estimated the average premium will more than double next year if the expanded subsidies were to expire.In addition to the potential ending of the subsidies, insurance rates are projected to rise across marketplace plans and employer-provided insurance."I looked at Medicare history, employer-sponsored insurance history, marketplace history. Without a doubt, this is the highest one-year increase in premiums for people in history," Lambrew said.The Get the Facts Data Team analyzed maximum out-of-pocket rate changes for benchmark plans to find how rates may change.A one-person household with an annual income of $25,000 — a little more than 1.5 times the federal poverty level — is estimated to go from paying a maximum $100 out of pocket annually to $1,168. They would pay a maximum of less than $98 a month — 10 times more than the previous payment of less than $9 a month.Households with an income between 100% and 150% of the federal poverty level made up the largest share of enrollees at almost 45%. Under the expanded subsidies, they aren't required to pay anything out of pocket for benchmark plans.If the tax credits expire, they will pay a maximum between 2.1% and 4.19% of their income annually. At 1.5 times the federal poverty level, a one-person household would be earning $23,475 annually and may have to pay nearly $984 a year.The interactive below shows how the maximum out-of-pocket rates for benchmark plans may change if expanded subsidies expire for one, two and four-person households at various incomes. Estimates were calculated using maximum out-of-pocket rates from KFF published by the IRS, along with 2025 federal poverty level data from the U.S. Department of Health and Human Services for the 48 contiguous states plus D.C. The tool is not intended to calculate an individual's actual payments. Healthcare.gov and other state marketplaces are the best source for specific premium costs.PHNjcmlwdCB0eXBlPSJ0ZXh0L2phdmFzY3JpcHQiPiFmdW5jdGlvbigpeyJ1c2Ugc3RyaWN0Ijt3aW5kb3cuYWRkRXZlbnRMaXN0ZW5lcigibWVzc2FnZSIsKGZ1bmN0aW9uKGUpe2lmKHZvaWQgMCE9PWUuZGF0YVsiZGF0YXdyYXBwZXItaGVpZ2h0Il0pe3ZhciB0PWRvY3VtZW50LnF1ZXJ5U2VsZWN0b3JBbGwoImlmcmFtZSIpO2Zvcih2YXIgYSBpbiBlLmRhdGFbImRhdGF3cmFwcGVyLWhlaWdodCJdKWZvcih2YXIgcj0wO3I8dC5sZW5ndGg7cisrKXtpZih0W3JdLmNvbnRlbnRXaW5kb3c9PT1lLnNvdXJjZSl0W3JdLnN0eWxlLmhlaWdodD1lLmRhdGFbImRhdGF3cmFwcGVyLWhlaWdodCJdW2FdKyJweCJ9fX0pKX0oKTs8L3NjcmlwdD4=
WASHINGTON — At the core of the government shutdown is a debate about the extension of health insurance subsidies under the Affordable Care Act, first implemented in 2021.
The shutdown began at the start of the new fiscal year, Oct. 1. In budget negotiations, were aiming to extend the expanded subsidies, set to expire at the end of 2025, while have emphasized reopening the government before beginning health care talks.
If these tax credits expire, it’s estimated that the more than 24 million people enrolled in marketplace plans will pay twice as much out of pocket, according to Jeanne Lambrew, director of health care reform at the Century Foundation. KFF the average premium payment would increase 114% from $888 to $1,904 without expanded subsidies.
Plus, the impacts could be felt even sooner as open enrollment is set to begin Nov. 1 for people to select health insurance coverage for 2026.
The ACA, sometimes referred to as "Obamacare," was designed to make health care affordable and accessible via marketplaces, Lambrew said, who also worked on drafting and implementing the ACA during the Obama administration.
The goal of the marketplaces were to fill in the gaps, according to Lambrew. It is for people who make too much to qualify for Medicaid, but also for people who don't have access to affordable insurance through their work.
Enrollment in the ACA has increased since its passage in 2014, but really climbed in the last five years.
From 2020 to 2025, enrollment more than doubled as a result of expanded tax credits passed in the American Rescue Plan Act in 2021, which increased the subsidies and lifted a cap that disqualified people making four times the poverty level or more from being eligible for the subsidies.
Under 2025 guidelines for the 48 contiguous states and Washington, D.C., the federal poverty level is $15,650 for a one-person household. At 400%, it's $62,600.
Nearly all states saw an increase in enrollment under the ACA from 2020 to 2025, with 20 states more than doubling in enrollment.
Six states more than tripled in the number of people enrolled under the ACA — Texas, Mississippi, West Virginia, Louisiana, Georgia and Tennessee.
States that President Donald Trump won in the 2024 election have the majority of enrollees, according to an analysis from KFF.
“We know that three out of four enrollees in the health insurance marketplace live in states that voted for President Trump in 2024,” Lambrew said. “So this is not a partisan issue, it's a nationwide issue, and it affects people in different ways, but the overall effect is significant.”
Who is impacted?
The subsidies, also called tax credits, at the center of the shutdown are utilized by about 92% of people enrolled in marketplace plans under the ACA, according to data from the Centers for Medicare & Medicaid Services.
These expanded credits allow households of different sizes and income levels to be capped with maximum out-of-pocket costs.
Once the expanded tax credits expire at the end of this year, the out-of-pocket maximums will increase across the board, and people making above four times the poverty level will become ineligible for any tax credits.
More than 6.7% of those who were enrolled in ACA plans earned more than 400% of the federal poverty level, accounting for 1.6 million people. Once the subsidies expire, these enrollees would no longer qualify for the subsidies under the ACA.
Also heavily impacted are people approaching retirement age. The age group with the highest enrollment in marketplace plans is ages 55 to 64, data shows.
KFF estimated in March that about half the enrollees who would lose the tax credit upon expiration are between 50 and 64.
As people grow closer to retirement age, they may not rely as much on employer-provided insurance before turning 65 and qualifying for Medicaid, according to Lambrew.
How much would premiums change?
the average premium will more than double next year if the expanded subsidies were to expire.
In addition to the potential ending of the subsidies, across marketplace plans and .
"I looked at Medicare history, employer-sponsored insurance history, marketplace history. Without a doubt, this is the highest one-year increase in premiums for people in history," Lambrew said.
The Get the Facts Data Team analyzed maximum out-of-pocket rate changes for benchmark plans to find how rates may change.
A one-person household with an annual income of $25,000 — a little more than 1.5 times the federal poverty level — is estimated to go from paying a maximum $100 out of pocket annually to $1,168.
They would pay a maximum of less than $98 a month — 10 times more than the previous payment of less than $9 a month.
Households with an income between 100% and 150% of the federal poverty level made up the largest share of enrollees at almost 45%. Under the expanded subsidies, they aren't required to pay anything out of pocket for benchmark plans.
If the tax credits expire, they will pay a maximum between 2.1% and 4.19% of their income annually. At 1.5 times the federal poverty level, a one-person household would be earning $23,475 annually and may have to pay nearly $984 a year.
The interactive below shows how the maximum out-of-pocket rates for benchmark plans may change if expanded subsidies expire for one, two and four-person households at various incomes. Estimates were calculated using maximum out-of-pocket rates from KFF published by the IRS, along with 2025 federal poverty level data from the U.S. Department of Health and Human Services for the 48 contiguous states plus D.C.
The tool is not intended to calculate an individual's actual payments. Healthcare.gov and other state marketplaces are the best source for specific premium costs.
