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Millions of Americans are entering 2026 facing sharply higher health insurance costs after expanded Affordable Care Act subsidies expired at the start of the year, driving premium increases that are already reshaping household budgets nationwide.

The enhanced tax credits, first introduced during the COVID-19 pandemic and later extended by Congress, officially lapsed as the new year began. Their expiration affects people who buy coverage on the ACA marketplace but do not receive insurance through an employer and are not eligible for Medicaid or Medicare, including many self-employed workers, small business owners, and rural residents.

Despite months of political maneuvering, lawmakers failed to act before the deadline. Democrats pushed to preserve the subsidies, triggering a lengthy government shutdown, while some Republicans acknowledged the looming impact but stopped short of backing legislation. A potential House vote in January could revive the credits, though the outcome remains uncertain.

For many families, the financial shock is immediate. Health policy researchers estimate that premium costs for subsidized ACA enrollees are rising by an average of more than 100 percent this year. The increase comes as overall health care expenses continue to climb, adding to out-of-pocket costs across many plans.

“It really bothers me that the middle class has moved from a squeeze to a full suffocation,” said Katelin Provost, a 37-year-old single mother whose monthly premium is jumping from $85 to nearly $750. “I’m incredibly disappointed that there hasn’t been more action.”

The subsidies had significantly lowered insurance costs since 2021. Lower-income enrollees often paid no monthly premium, while middle-class households were shielded from paying more than a fixed share of their income. With those protections gone, many are now reassessing whether they can afford coverage at all.

Some enrollees are absorbing the increases despite the strain. Stan Clawson, a freelance filmmaker in Utah who lives with paralysis from a spinal cord injury, said his premium is rising from about $350 a month to nearly $500. “It’s difficult, but going without insurance isn’t an option for me,” he said.

Others say the new costs are simply untenable. Lori Hunt, an Iowa resident and breast cancer survivor who lost her job last year, said she would be forced to drop coverage entirely without the subsidies. “It would cost more than my mortgage,” she said. “I couldn’t afford it.”

Health policy analysts warn that millions of people may make the same decision. Projections suggest that nearly five million Americans could lose coverage in 2026 as higher premiums push younger and healthier enrollees out of the marketplace, potentially driving costs even higher for those who remain.

States with the largest ACA enrollment, including Florida, Texas, California, Georgia, and North Carolina, are expected to feel the effects most sharply. In Florida, where enrollment is highest, some residents report premiums more than doubling.

“Our premium is effectively tripling,” said Kylie Barrios, a Florida small business owner whose monthly costs are expected to rise from about $900 to $2,500. “The system just isn’t working for people like me.”

With open enrollment still underway in most states until mid-January, the full impact on coverage rates is not yet clear. Some Americans are holding out hope that Congress will revive the subsidies early this year, while others are already preparing to scale back coverage or drop it entirely.

Provost said she plans to keep insurance for her young daughter but may go without coverage herself if prices remain unchanged. “I just can’t afford both,” she said.

Frustration with lawmakers cuts across party lines. Many enrollees say the issue highlights deeper problems with affordability in the U.S. health care system.

“Both parties have talked about fixing this for years,” said Chad Bruns, a Wisconsin enrollee. “Then do it. People like me are running out of options.”

As Congress debates its next steps, millions of Americans are left navigating higher costs, fewer choices, and growing uncertainty about access to health care in the year ahead.