As the expiration of the enhanced premium subsidies looms, Democrats are gearing up for a fight to save them.
Prominent Senate Dems released the results of a commissioned report examining the potential impacts of the end of the premium tax credits, which contributed directly to record highs in enrollment for plans available on the Affordable Care Act's insurance marketplaces.
The report, commissioned by Sens. Ron Wyden, D-Oregon, and Jeanne Shaheen, D-New Hampshire, notes that the Congressional Budget Office estimates 4.2 million people will lose insurance coverage if the tax credits expire. Individuals who remain in exchange plans will see their net premiums increase by 75% on average.
The report was compiled by the Georgetown University Center on Health Insurance Reforms, and it also says that other policy changes rolled out recently will play a role in coverage losses in the ACA marketplace. The broad reconciliation bill could lead 2.4 million people to lose ACA coverage, while a market integrity rule finalized in June could impact coverage for as many as 1.8 million.
Overall, the report suggests that enrollment in exchange plans could decrease by as much as 57%.
And insurers are baking these assumptions into their rate filings for 2026, per the report. They're expecting to see significant coverage losses and shifts in the risk pool, and the median rate increase proposed for the coming year is 18%.
“Thanks to the Affordable Care Act, tens of millions of working Americans can buy their own health coverage without breaking the bank," Wyden said in a press release. "Republicans letting the ACA tax credits expire will only increase health care costs and worsen coverage for struggling families."
“We stand ready to work with anyone who wants to extend these benefits, making sure that Americans can access quality, affordable health care," Wyden added.
Alongside the report, last week Wyden joined two other colleagues in sending a letter to insurers participating in the marketplaces for 2026, looking for their feedback on how these policy changes could impact coverage and costs for the exchange market.
The letter was first obtained by Axios.
The letter (PDF), joined by Sens. Chuck Schumer, D-New York, and Bernie Sanders, I-Vermont, asks specifically about the impact of the tax credits' expiry on premiums, coverage losses and risk pools. They also ask plans to discuss how enrollments from younger, healthier individuals plays a role in balancing out the risk pool, and how that could be disrupted by recent policy changes.
It also asks specifically about additional details on how these policy changes could impact individuals living in rural areas.
"Taken together, these actions are sending the ACA Marketplaces into a death spiral," the senators wrote. "As House and Senate Democrats work to avert this catastrophe—urging Republicans to act—we ask that you share information with Congress, and with your enrollees, that only your organizations and members can provide on the consequences of Republicans’ ACA policies for the health and well-being of American families."