What congressional districts will be hurt the most if the ACA subsidies expire?
Lynne Cotter
Oct 9, 2025 KFF
Nationally, individuals and families buying subsidized ACA coverage will see their premium payments more than double on average if the enhanced tax credits expire. Increases for out-of-pocket premium payments are not uniform, however, and older people with incomes over four times poverty would be hit hardest.
How enrollees would experience the premium changes in 2026 varies by income, age, and geography. Without the enhanced tax credits, the out-of-pocket premium for an individual, age 40, with an annual income of $32,000, would rise by $122 per month, or about three times the premium payment with enhanced tax credits. This increase will happen in most congressional districts, except Alaska and Hawaii due to their different poverty level guidelines. In Alaska, monthly premium payments would increase from $15 out-of-pocket to $129 if the enhanced tax credits expire, a similar dollar increase but a jump of nearly 800%.
Premiums would increase most for older adults making just over 400% of the federal poverty level, since they would no longer qualify for any premium tax credits. For a 60-year-old couple making $85,000 a year, losing the enhanced tax credits would increase their premiums by about $1,900 per month, based on a national average premium increase of 18%. There is wide variation in average state-requested premium increases and in insurance costs within congressional districts. Among the five congressional districts with the highest premium increases, premiums will increase by over 500%.
For a 60-year-old couple making $85,000, the congressional districts with the greatest increases per month:
WY: 693% ($602 to $4,777)
WV01: 654% ($602 to $4,540)
WV02: 599% ($602 to $4,210)
CT04: 537% ($602 to $3,833)
IL12: 535% ($602 to $3,823)
The congressional districts with the smallest increases in the continental U.S. are all in New York, which uses community rated premiums:
NY26: 110% ($602 to $1,265)
NY23: 119% ($602 to $1,317)
NY24: 142% ($602 to $1,457)
NY22: 143% ($602 to $1,461)
NY20: 150% ($602 to $1,505)
The map below shows congressional district level ACA Marketplace out-of-pocket premium increases should the enhanced premium tax credits expire, for a 40-year-old individual making $32,000, and a 60-year-old couple making $85,000.
Figure 1
Premium Payments for Subsidized Enrollees Will Increase Nationwide if Enhanced ACA Subsidies Expire
Percent Increase in Average Monthly Premium Payments for Benchmark Silver Plan Without Enhanced Subsidies, 60-Year Old Couple Making $85,000, 2026
40-Year-Old, $32,000 60-Year Old Couple, $85,000
< 100%100%–200%200%–300%300%–400%≥ 400%
Note: Premiums reflect the state median increase from rate filings applied to 2025 amounts and weighted by plan selections. Premiums do not reflect state-provided subsidies. Hawaii and Alaska have different federal poverty levels; the premium increase for an Alaskan 60-year-old couple making 401% of poverty would be substantially higher.
