• Trump’s approval rating sits at 36% in Gallup poll, lowest for first-year president in 50 years
• Enhanced ACA tax credits expired overnight, driving average premium increases of 114% for over 20 million Americans
• House vote expected in January on subsidy extension, but Senate already rejected similar proposal in December

WASHINGTON, DC (TDR) — More than 20 million Americans woke up Thursday to sharply higher health insurance costs as enhanced Affordable Care Act subsidies expired overnight, marking the end of pandemic-era relief that had kept premiums affordable for millions of enrollees since 2021.

The expiration came after months of congressional battles, a record-breaking 43-day government shutdown, and ultimately failed bipartisan negotiations that left the subsidies to lapse at the stroke of midnight on January 1.

Subsidized enrollees are seeing their premium costs rise by 114% on average in 2026, according to health care research nonprofit KFF. For many families, that translates to monthly premiums jumping from a few hundred dollars to well over $1,000 — or in some cases tripling from $900 to $2,500.

Freedom-Loving Beachwear by Red Beach Nation - Save 10% With Code RVM10

The health care crisis arrives as President Donald Trump enters 2026 with approval ratings near historic lows, creating compounding political headwinds as the midterm election year begins.

Premiums Jump from Hundreds to Thousands

The expired subsidies were first provided in 2021 as a temporary pandemic measure to help Americans get through COVID-19, then extended by Democrats with an expiration date set for the start of 2026. Under the enhanced program, some lower-income enrollees received health coverage with no premiums, while high earners paid no more than 8.5% of their income.

The change affects a diverse cross-section of Americans who don’t receive health insurance from employers and don’t qualify for Medicaid or Medicare, including many self-employed workers, small business owners, farmers, ranchers and freelance professionals.

Salt Lake City freelance filmmaker Stan Clawson watched his monthly premiums jump from just under $350 to nearly $500 — a strain for the 49-year-old who lives with paralysis from a spinal cord injury and needs consistent health coverage.

CLICK HERE TO READ MORE FROM THE THE DUPREE REPORT

Others face even steeper increases. Social worker Kimberly Provost saw her monthly premium payment skyrocket from $85 to nearly $750. “Our health insurance premium is effectively tripling from 2025 to 2026,” another enrollee told CBS News, describing increases from about $900 to $2,500.

Cancer survivor Michelle Hunt, laid off in 2025, expected her ACA premium would jump to about $700 per month without the subsidies. “It would be more than my mortgage payment,” Hunt said.

Provost, a single mother, said she’s holding out hope Congress finds a way to revive the subsidies early in the year — but if not, she’ll drop herself off the insurance and keep coverage only for her 4-year-old daughter. She can’t afford to pay for both at the current price.

Congressional Impasse Continues

Democrats and Republicans fought bitterly over the subsidies throughout late 2025, with Democrats forcing a 43-day government shutdown — the longest in US history — demanding their extension. The shutdown ended in mid-November with an agreement to hold a Senate vote on the matter.

Both Democratic and Republican health care bills failed to pass the Senate in mid-December. Democrats proposed extending the subsidies for three years, while Republicans offered an alternative providing Americans with health savings accounts instead.

In the House, four centrist Republicans broke with GOP leadership and joined Democrats to force a vote expected in January on a three-year extension. However, with the Senate having already rejected such a plan, success remains uncertain.

Trump floated giving money directly to Americans to purchase their own insurance but backed off after conservative backlash. He later said he wants to meet with health insurance companies to demand rate cuts, though he has not provided specific details.

Projected Coverage Losses

Health analysts predict the subsidy expiration will drive many of the 24 million total ACA enrollees — especially younger and healthier Americans — to forgo coverage altogether. An Urban Institute and Commonwealth Fund analysis projects the higher premiums will prompt approximately 4.8 million Americans to drop coverage in 2026.

The impact will fall unevenly across states. Eight states — Georgia, Louisiana, Mississippi, Oregon, South Carolina, Tennessee, Texas and West Virginia — are projected to lose more than half their subsidized marketplace enrollment.

Americans have until January 15 in most states to select or change plans, with coverage beginning February 1. The final effect on enrollment won’t be clear until April at the earliest, as consumers who stop paying premiums remain covered for three months before policies terminate.

Senate Democratic Leader Chuck Schumer blamed Republican obstruction for what he described as a health care crisis. “Millions of hard-working families, small business owners and employees, older Americans and farmers and ranchers will face impossible choices,” Schumer said.

The convergence of expired subsidies and sharply rising health costs poses immediate hardship for millions of Americans while creating political challenges for both parties heading into the 2026 midterm elections, with affordability topping voters’ list of concerns. A Gallup poll showed Trump’s approval at just 36% in late December, the lowest for any first-year president in 50 years.

Will Congress extend the subsidies in January, or will millions of Americans lose health coverage as premiums become unaffordable?

Freedom-Loving Beachwear by Red Beach Nation - Save 10% With Code RVM10