With open enrollment for Affordable Care Act coverage in full swing, experts are warning that Congress may have run out of time to implement the health policy changes Republicans are demanding. As both parties remain locked in a budget standoff, millions of Americans could soon face higher premiums and reduced coverage options.
A Missed Deadline?
The enhanced ACA subsidies, which have helped roughly 24 million Americans afford health insurance since 2021, according to KFF, are set to expire at the end of this year unless Congress acts. These subsidies have lowered monthly premiums for many middle- and lower-income households.
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Republican lawmakers have signaled they're open to extending the aid — but only if changes are made, such as tightening income limits or requiring recipients to pay at least a small portion of their premiums, according to Axios. However, with open enrollment starting, experts say it's nearly impossible to roll out those modifications.
"I have zero confidence that there's enough operational time for systems and issuers to be able to implement significant changes," Jeanne Lambrew, a former health adviser in the Obama administration and Maine's former health commissioner, told Axios.
Insurers and States Sound the Alarm
Insurers and state-run exchanges are already preparing for 2026 coverage under the assumption that no new deal will pass before enrollment begins. Several states have even sent notices to residents outlining expected premium hikes if the enhanced subsidies lapse.
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In Maryland, for instance, the average ACA premium could rise 35% next year, even with some backup state assistance. One middle-income family of four could see their monthly cost jump from $916 to $1,427, according to KFF.
"At this point in the calendar, the lowest risk option is an extension of the same framework that the enhanced tax credits have today,” Devon Trolley, executive director of Pennsylvania's ACA marketplace, told Axios.
"We Just Can't Flip a Switch Overnight"
ACA administrators across the country say they're ready to adjust if Congress acts, but only if lawmakers move quickly. Jessica Altman, executive director of Covered California, told KFF that her team could update the marketplace within about a week if Congress simply renews the existing subsidies.
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But if major changes are introduced, the process becomes far more complex. "We just can't flip a switch overnight," Maryland Health Benefit Exchange Executive Director Michele Eberle told KFF. Some states are even considering pausing enrollment temporarily if Congress passes new rules midseason.
What's Next for Consumers
Without congressional action, many consumers will soon see steep premium increases and higher deductibles. In Virginia, some families are being offered plans with deductibles jumping from $800 to $20,000, according to KFF. Experts warn that such price hikes could push younger and healthier Americans to drop coverage altogether, leaving insurers with older, costlier enrollees.
While a last-minute deal could still extend the subsidies as they currently stand, time is running out. For now, ACA enrollees are being urged to review their coverage carefully and prepare for potential price increases — regardless of what Congress decides.
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