ACA Enrollment Ends Amid Lapsed Subsidies as Abortion‑Coverage Fight Stalls Fix in Congress
Open enrollment ends in most states as enhanced ACA premium tax credits have lapsed, with sign‑ups down to 22.8 million—about 1.4 million fewer than a year ago—and analysts warn premiums for subsidy recipients could more than double (KFF estimates a ~114% jump), a change the CBO says could ultimately leave roughly 4 million people uninsured without congressional action. The House advanced a three‑year "clean" extension in a 221–205 procedural vote after several Republicans crossed party lines, but Senate negotiations are near collapse over proposed limits on abortion coverage—pressure from anti‑abortion groups has complicated a deal—leaving a fix uncertain even though Congress can still extend subsidies retroactively and several states have extended enrollment deadlines.
📌 Key Facts
- The House moved to approve a three‑year "clean" extension of enhanced ACA premium tax credits after a procedural advancement vote of 221–205, with final passage expected Thursday.
- Multiple House Republicans joined Democrats to force the vote — nine GOP defectors on the key procedural vote and later reports that 17 backed the extension after a private message from former President Trump; four Republicans (Reps. Mike Lawler, Brian Fitzpatrick, Ryan Mackenzie and Rob Bresnahan) had signed the original discharge petition.
- Rep. Mike Lawler said bipartisan talks failed to produce a compromise before Christmas, leaving the three‑year extension as the only available vehicle, and argued strong House support could help push negotiators in the Senate toward a deal.
- Senate negotiations are unlikely to approve the House bill in its current form and are reported to be near collapse largely because of a fight over whether exchange plans should include limits on abortion coverage; anti‑abortion groups are pressuring GOP lawmakers against compromise.
- Enhanced subsidies expired last month; as of Jan. 12 CMS reported 22.8 million people had signed up for 2026 ACA coverage — about 1.4 million fewer than a year earlier — and more than 20 million Americans received the enhanced credits last year.
- Independent analyses show steep affordability impacts if credits are not restored: KFF estimates average premiums for affected enrollees would rise roughly 114% (from about $888 to $1,904/month), CBO projects about 4 million could lose insurance, and Urban Institute found benchmark silver premiums up nearly 22%.
- Health economists and advocates warn of significant coverage loss and an affordability crisis — Robert Kaestner estimates roughly 2 million more people may be uninsured temporarily while some shift to employer plans or Medicaid, Republicans say letting credits lapse saves about $35 billion a year, and advocates report overnight premium spikes and people dropping coverage (for example, a 59‑year‑old Florida enrollee who went uninsured).
- Ten states plus the District of Columbia extended their open‑enrollment deadlines beyond Jan. 15, and Congress could still extend subsidies retroactively for tax year 2026 because ACA premium subsidies are refundable tax credits calculated annually.
- The House measure is widely viewed as a vehicle for a Senate compromise that would include reforms, and the defections underscored an intra‑party rupture in GOP leadership as moderates joined Democrats to advance the extension.
📊 Relevant Data
If enhanced ACA subsidies expire in 2026, non-Hispanic Black Americans are projected to experience a 30% increase in uninsurance rates, with 925,000 more becoming uninsured, compared to a 25% increase for non-Hispanic Whites (2.3 million more uninsured) and 15% for Hispanics (1.3 million more uninsured); this represents Black Americans accounting for 19% of total coverage losses despite comprising about 13% of the U.S. population, Hispanics 27% of losses despite 19% of population, and non-Hispanic Whites 48% of losses despite 58% of population.
4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire — Urban Institute
In 2024, Black Americans represented 16.3% of ACA Marketplace plan selections (2.7 million enrollees) despite comprising about 13% of the non-elderly adult U.S. population, Latinos 29.4% (4.8 million) despite 21.3% of population, and Whites 45.8% (7.5 million) despite 54.3% of population, showing overrepresentation of Black and Latino groups in subsidy-dependent enrollment.
HealthCare.gov Plan Selections by Race and Ethnicity, 2015-2024 — ASPE (Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services)
Approximately 3.7 million people were enrolled in ACA Marketplace plans in 2023 in the 12 states that require abortion coverage, potentially affected by proposed federal restrictions or audits on fund segregation for elective abortions.
Deja Vu: the Future of Abortion Coverage in ACA Marketplace Plans — KFF
📰 Source Timeline (6)
Follow how coverage of this story developed over time
- Confirms that although there is broad bipartisan support for reviving lapsed ACA subsidies, Senate negotiations are 'near collapse' because of disagreement over abortion coverage limits in exchange plans.
- Adds detail that anti‑abortion groups are pressuring GOP lawmakers not to compromise after the House passed a three‑year extension without new abortion restrictions.
- Reports that Trump’s private message urging Republicans to be 'a little flexible' on abortion-funding rules preceded 17 House Republicans backing the extension, clarifying the political dynamics around the House vote.
- Confirms 2026 ACA enrollment at 22.8 million as of Jan. 12, down 1.4 million from the prior year, and ties that decline explicitly to the lapse of enhanced premium tax credits.
- Reports that average 2026 premiums for benchmark silver plans have risen nearly 22%, versus a projected increase of no more than 7% for employer plans, based on new Urban Institute analysis.
- Details KFF’s estimate that, absent congressional action, premiums could more than double this year for the more than 20 million Americans who previously received the enhanced credits.
- Notes that the lapse in subsidies and resulting affordability crisis were central to the six‑week government shutdown, underscoring the scale of the political standoff.
- Adds concrete anecdotal evidence of people dropping coverage, such as a 59‑year‑old Florida enrollee who says her family is going uninsured because the ACA plan is now cost‑prohibitive.
- Lists the 10 states plus D.C. that have extended open‑enrollment deadlines beyond Jan. 15, with specific end dates.
- Quotes Community Catalyst’s Michelle Sternthal warning that failure to extend credits has already produced an overnight spike in premiums and a broader 'health care affordability crisis.'
- Clarifies that Congress can still extend subsidies retroactively for tax year 2026 even after open enrollment ends, because ACA premium subsidies are refundable tax credits calculated annually.
- CMS reports 22.8 million people have signed up for 2026 ACA coverage since Nov. 1, about 1.4 million fewer than a year ago, a roughly 3.5% national drop at this point in enrollment.
- KFF estimates that, absent an extension of enhanced tax credits, average ACA premiums for affected enrollees will jump about 114%, from roughly $888 a month in 2025 to $1,904 in 2026.
- The article notes over 20 million Americans received the enhanced ACA subsidies last year and relays CBO’s projection that 4 million people will eventually lose insurance without an extension.
- Health economist Robert Kaestner predicts about 2 million more people will be uninsured for a time, while some may shift to employer plans or Medicaid, and says Republicans argue they are saving about $35 billion a year by letting the subsidies lapse.
- Provides the exact House advancement vote tally of 221–205, which was not explicitly in the summarized description.
- Clarifies timing that final passage is expected Thursday following this key procedural hurdle.
- Adds framing that Speaker Mike Johnson and GOP leadership were 'overpowered' as moderates joined Democrats, underscoring the intra‑conference rupture.
- Includes a new quote from Rep. Mike Lawler about how strong bipartisan House support can help drive a Senate compromise.
- Gives more detail that the subsidies had expired the previous month and that about 22 million people benefited from them.
- CBS reports that the House is on track Thursday to approve a three-year extension of enhanced ACA premium tax credits, with a growing number of Republicans expected to join Democrats.
- Confirms that nine Republicans voted with all Democrats on a Wednesday procedural vote to advance the bill, up from the four who initially signed the discharge petition last month.
- Identifies the four GOP signers of the discharge petition by name: Reps. Mike Lawler, Brian Fitzpatrick, Ryan Mackenzie and Rob Bresnahan.
- Provides on-the-record comments from Rep. Mike Lawler explaining that attempted bipartisan negotiations on a compromise bill failed to secure a vote before Christmas, leaving the three-year 'clean' extension as the only available vehicle.
- Notes that the three-year extension is unlikely to pass the Senate in its current form but is widely seen as a vehicle for a Senate compromise that would include reforms.
- Adds fresh detail that Sen. Susan Collins says negotiators are 'continuing to work hard' on a compromise measure and that parts will resemble her initial proposal with Sen. Bernie Moreno.