Millie Haas’s life depends on having affordable health insurance through Obamacare.
The disabled Okeechobee, Florida, resident is battling three types of cancer and a neurological condition. She and her husband, a retired maintenance worker, would have a tough time paying for coverage on their fixed incomes were it not for the enhanced federal subsidies that lower their monthly premium to $124. And she wouldn’t be able to afford to see the 11 specialists who care for her if she were uninsured.
“For me, no insurance is death,” said Haas, 58, a former human resources staffer who has had to scrimp to pay up to $9,000 a year out-of-pocket for her treatment. “That extra money is very crucial.”
Haas and millions of other Americans will likely suffer sticker shock next month when they learn what their Obamacare premiums will be for 2026. That’s because the beefed-up subsidies enacted during the Biden administration are set to expire at the end of this year — which would send premiums skyrocketing by 75%, on average, according to KFF, a nonpartisan health policy research group.
Ironically, it’s up to congressional Republicans, who have tried repeatedly to repeal the Affordable Care Act, to extend the enhanced subsidies — which have helped draw a record 24 million people to sign up for 2025 Obamacare coverage. Roughly 92% receive assistance.
GOP leaders are now under heavy pressure from an array of Obamacare supporters, Democrats and even some swing-district Republican members to renew the assistance, while GOP fiscal conservatives are vowing never to come to the aid of the program. Renewing the subsidies for one year would cost about $30 billion, according to a source familiar with the matter.
The extension has become a central factor in the debate over funding the federal government for the coming fiscal year, which must be done by September 30 to avoid a shutdown. Democrats are warning they will not vote for a stopgap bill to keep the government operating if it doesn’t include a measure to continue the beefed-up subsidies.
But Senate Majority Leader John Thune and House Speaker Mike Johnson are not rushing to prevent a spike in premiums, even as at least one poll found that the majority of Americans, including Republicans, support continuing the more generous assistance.
The House is moving to extend government funding to mid-November through a so-called “clean” continuing resolution, which President Donald Trump supported in a Truth Social post on Monday.
Administration officials, however, are considering whether to back some form of an extension into 2026. The issue “is definitely on the radar, both with members in Congress, but also at the White House,” Mehmet Oz, who runs the Centers for Medicare and Medicaid Services, which administers Obamacare, told reporters Tuesday, noting there are “conversations happening daily on that topic.”
Johnson on Tuesday rejected including an extension of the subsidies in the government funding bill, telling reporters, “We have time to have that debate, and it’s not something that should be involved in the government funding deadline at the end of September.”
While Thune has acknowledged that he personally isn’t opposed to letting the enhanced subsidies lapse, he said that he won’t allow an extension to be tied to a stopgap bill.
“I think the ACA subsidies will be an issue that will be addressed, but I think right now we’ve got to keep the government open,” Thune said Tuesday. “I don’t think there’s going to be anything close to ready to go by the shutdown of the government, which would happen on September 30.”
However, time is of the essence, advocates say. Open enrollment typically runs from early November into mid-January, though it can vary by state.
Consumers will be able to start viewing the 2026 premiums in October, and many could be deterred from signing up by the much bigger price tags, said Jennifer Sullivan, director of health coverage access at the left-leaning Center on Budget and Policy Priorities.
“People either come in during window shopping or open enrollment and say, ‘Oh my word, that is not something I can afford,’” she said. “Getting them back is not real likely.”
State exchange officials are also pushing Congress to act before the end of the month.
“Extending the enhanced tax credits after September 30 will cause confusion, and many consumers will go uninsured,” Pat Kelly, executive director of Your Health Idaho, the state’s Obamacare exchange, told reporters earlier this month. “Reacquiring those customers is multiple times more expensive than retaining them.”
Making Obamacare more affordable
The Democratic-controlled Congress enacted the subsidy enhancement in 2021 as part of former President Joe Biden’s sweeping Covid-19 pandemic relief package and then renewed it in 2022. The provision enables many lower-income Americans to obtain coverage with no or very low monthly premiums and broadens eligibility for assistance to many middle-class consumers.
But the more generous aid also opened up the exchanges to fraud, mainly by brokers and agents who sought to earn commissions by enrolling people in Obamacare policies or switching them to new ones without their knowledge or consent. This has bolstered Affordable Care Act opponents’ arguments that the beefed-up subsidies should be allowed to lapse.
“These temporary emergency subsidies were never meant to become a permanent, deficit-financed entitlement that conceals — rather than fixes — the drivers of high premiums,” Maryland Rep. Andy Harris, who chairs the conservative House Freedom Caucus, said in a statement to CNN. “As a physician, I believe reforms should prioritize affordability and access — not funnel billions of taxpayer dollars to insurance companies.”
If the subsidies expire, consumers are expected flee the exchanges. About 4 million more people would be uninsured in 2034, according to a Congressional Budget Office analysis — and that’s on top of the roughly 10 million more people who will lack coverage due to the One Big Beautiful Bill’s Medicaid and Affordable Care Act provisions. What’s more, Obamacare premiums would rise since many of those remaining on the exchanges would be sicker and more costly.
Residents of many red states will likely be hit disproportionately hard if the enhanced subsidies end. More than half of those who will become newly uninsured live in Texas, Florida, Georgia and North Carolina, according to a KFF analysis.
“A lot of the coverage loss will be concentrated in Southern red states since those are the states where we saw the most growth from the enhanced tax credits,” said Cynthia Cox, director of KFF’s Program on the Affordable Care Act. “That’s also where there are a lot of low-income people who would be on Medicaid if their state had expanded Medicaid.”
Anna, a resident of Marietta, Georgia, is one of those who signed up for an Obamacare policy in recent years after going through a divorce. She pays $82 a month for coverage, which allows her to afford continued treatment for back and neck injuries sustained in two recent car accidents. That care, in turn, allows her to work in marketing and sales for a small company that doesn’t offer health insurance.
Anna fears her monthly premiums might soar by 50% to $120 next year, based on what KFF’s online subsidy calculator told her. That might force her to have to give up her car since she would have trouble affording the loan.
“That may not seem like much to some people,” said Anna, 34, who requested her last name not be used for privacy reasons. “But when you’re trying to live and pay bills, that makes a difference.”
States are already bracing for an exodus of enrollees. In Idaho, about 25,000 residents are expected to cancel their coverage if the enhancement lapses, Kelly said. That’s about 20% of the state’s enrollment, which hit a record 136,000 this year.
“These are ranchers in eastern Idaho, farmers in northern Idaho, and the small business owners all across the state who will have to make a gut-wrenching decision — invest in their business or choose health insurance,” he said.
Kelly told CNN that the exchange has been planning for months on how to inform customers if the subsidies are extended before, during or after the state’s open enrollment period begins on October 15. It plans to reach out through mailed and emailed notices, text messages and paid advertising, among other channels. It has also provided the more than 1,200 agents and brokers it works with a list of their clients and information to share with them.
Insurers are also pressuring lawmakers to act this month to avoid disruption but are reviewing their options if that doesn’t occur.
“Plans are certainly committed to operationalizing an extension no matter when it happens, even if it is New Year’s Eve,” said David Merritt, senior vice president of external affairs for the Blue Cross Blue Shield Association.
Widespread support for enhanced subsidies
The enhanced subsidies are broadly popular, so allowing them to end could prove uncomfortable for GOP leaders, who want to avoid a repeat of the 2018 midterm elections when the party lost control of the House in the wake of the Obamacare repeal efforts.
Some 63% of Republicans say that Congress should extend the beefed-up assistance, as do 56% of Republicans and GOP-leaning independents who identify themselves as supporters of Trump’s Make American Great Again movement, according to a June KFF poll. That view is also held by 91% of Democrats and 80% of independents.
Democrats, who already hammered the GOP on the estimated coverage loss from the tax and spending cuts package, are now focusing on the subsidies ahead of the government funding showdown. They point out that Republicans opted not to renew the more generous subsidies — known as advance premium tax credits — as part of Trump’s domestic agenda package earlier this year.
“ACA tax credits must be expanded,” Senate Minority Leader Chuck Schumer said at a press conference Tuesday. “We believe that firmly and strongly, not just to save Americans thousands more each year that they’d have to pay, but for the very lives that are at stake if this expires.”
Some Republican lawmakers are acknowledging their vulnerability. Virginia GOP Rep. Jen Kiggans, along with a bipartisan group of colleagues, introduced in early September a bill that would extend the subsidies for another year.
Without the renewal, a family of four in her district earning $64,000 could see their annual premiums jump by more than $2,500, and a 60-year-old couple earning $82,800 would face a nearly $12,000 spike, she said in a statement.
“While the enhanced premium tax credit created during the pandemic was meant to be temporary, we should not let it expire without a plan in place,” she said. “We can’t pull the rug out from under hardworking families—we must give Americans more time to plan.”
A one-year extension, however, would mean that the premium hikes would hit just before the midterm election, which Republican lawmakers would likely want to avoid.
Haas, the Florida cancer patient, urged lawmakers on Capitol Hill to talk to their constituents, particularly those on fixed income.
“We need these legislators to wake up,” she said. “Without this assistance, there are a lot of people who won’t be able to get meds, they’re not going to be able to have food.”
CNN’s Morgan Rimmer, Alison Main, Ted Barrett, Sarah Ferris and Adam Cancryn contributed to this story.