The lapse of the Affordable Care Act's extra subsidies and the rise in premiums

The subsidies were at the heart of the fall 2025 government shutdown, which is followed in its own arc.^[5] In November the White House circulated a proposal to extend them for two years,^[5] but in December Congress deadlocked over dueling Democratic and Republican bills,^[6] and House Republicans unveiled a narrow health package that did not extend them.^[7] Four moderate House Republicans joined Democrats in a petition to force a vote on an extension,^[8][9] but the credits lapsed at the new year.^[1]

A KFF survey in March 2026 found many former marketplace enrollees struggling with health costs.^[10] In July insurers proposed a median 14% premium increase for 2027,^[3] driven by rising medical costs and policy changes by Congress and the administration.^[2] In September Vice President JD Vance and Dr. Mehmet Oz, who runs the Centers for Medicare and Medicaid Services, announced the removal of about 760,000 people from coverage.^[4] The cuts to Medicaid are followed in a related arc.