Democratic U.S. Sen. Chuck Schumer of New York, accompanied by Democratic U.S. Sen. Cory Booker of New Jersey, points to a poster depicting rising medical costs if Congress allows the Affordable Care Act tax credits to expire. (Photo by Andrew Harnik/Getty Images)

States are preparing for the possibility of a rapid shift in the cost of Obamacare health plans, depending on whether Congress extends the subsidies that are at the center of the federal government shutdown.

No matter what Congress does, the amount insurers charge for coverage sold on the marketplaces created by the Affordable Care Act will increase by an average of 26% in 2026, according to KFF, a health research nonprofit. In the 30 states that use the federal Healthcare.gov, premiums will rise by an average of 30%. In the states that run their own marketplaces, the average increase will be about 17%.

But 22 million of the 24 million people who are enrolled in marketplace plans receive a tax credit. If Congress extends the credits, the amount subsidized enrollees pay each month won’t significantly change, even as insurers charge more.

If Congress doesn’t act, people with incomes below 400% of the federal poverty level will receive less financial help, while people making more than that amount will not get any help at all. As a result, according to KFF, monthly premium payments for all enrollees will increase by an average of about 114%,

For a month, Republicans and Democrats have been in a stalemate over whether to extend these subsidies, leading to a government shutdown. The situation has created ambiguity for the states that run their own marketplaces, as many of them move this weekend into the open enrollment period for people to purchase health plans.

Some states, such as Maryland, are preparing for a scenario in which they would either extend state-funded subsidies to enrollees to help them keep their plans, or rapidly apply federal subsidies if Congress extends them.

“It’s going to vary state by state based on their technological abilities and if they need to do anything with their rates,” Michele Eberle, executive director of the Maryland Health Benefit Exchange, said in a phone interview.

Eberle said Maryland created a state subsidy program to make up for some of the federal subsidies that are in limbo. She said that if Congress extends the subsidies, enacting changes for the state’s 240,000 marketplace enrollees could take around three weeks.

Maryland would have to ask health insurers to resubmit their rates. The state also might have to send notices to enrollees to give them the opportunity to change their choice of plan, according to Eberle.

“We would change [enrollees’] premiums. We would have to back out the state subsidy [that we] put in, if there’s a new rate, put the new rates in, recalculate the new premium tax credit and apply that,” Eberle said.

In California, where two million people are enrolled in Covered California, residents are already reeling from sticker shock after seeing next year’s premiums on the state’s website.

“People are very stressed about what to do and what their options are with these cost changes,” Jessica Altman, executive director of California’s marketplace, said in an interview. “At the same time, we are very much ready, and we’ll move any mountain that we can possibly move if Congress does act.”

Altman said the state will automatically recalculate what enrollees would pay for their plans if Congress extends the credits, and is prepared for people to want to change their plans if federal lawmakers act.

“We’re also very much going to want to inform our consumers and give them the opportunity to make a different choice,” she said.

Altman said notifying enrollees’ of changes should take a few weeks, but changing information in the state’s system should only take about a week.

“Even when the enhanced tax credits passed the first time, it was in the middle of the year, in the spring,” Altman said.

“All the state exchanges had to build that, and it was done in a matter of weeks, right? So, that’s who we are, and that’s how we’re thinking about this challenge.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org

The U.S. Capitol on the evening of Tuesday, Sept. 30, 2025, just hours before a federal government shutdown. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — The vast majority of Americans, including Republicans and those who identify as strong supporters of President Donald Trump, want Congress to renew the enhanced tax credits for people who buy their health insurance from the Affordable Care Act Marketplace, according to a poll released Friday. 

More than 78% of people surveyed by the nonpartisan health organization KFF in late September said they want lawmakers to keep the enhanced credits. Their extension has become a major linchpin in debate about the government shutdown. 

When broken down by political party, 92% of Democrats, 82% of independents and 59% of Republicans supported renewing the credits.

Within the Republican Party, 57% of people who identified as supporting Trump’s Make America Great Again policies and 70% of GOP voters who identified as non-MAGA supporters want to see the tax credits extended, according to the poll.  

Spending bill held up over tax credit debate

The ACA tax credit expansion was created by Democrats in a coronavirus relief bill approved during the Biden administration and set to expire at the end of the year. 

Democrats have repeatedly called on Republicans to negotiate an extension of the enhanced tax credits and have held up a stopgap spending bill to force those talks to happen now, rather than later in the year. 

Speaker Mike Johnson, R-La., said Thursday the discussion should happen during the next few months and that GOP lawmakers will press for “major reform.” 

“That’s not a simple issue. That’s going to take weeks to deliberate and discuss and debate, but that’s the beauty of the process. We have three months to do that. That is not an issue for today,” Johnson said. “Today the only issue is whether they’re going to vote to keep the government operating for the people.”

Democrats strongly disagree, saying a bipartisan accord must be struck before the open enrollment period for ACA plans begins on Nov. 1, when consumers will see large cost increases for next year. 

“We can’t accept an empty promise, which is, ‘Oh, we’ll deal with this later,’” Sen. Patty Murray, D-Wash., said on a call with reporters Thursday. “The fact is that this crisis is in front of us now. People are getting this month their premium increases if the Senate does not act.”

Murray said she finds it “ironic” that Republican leaders are saying they’ll negotiate with Democrats on health care once the government reopens after they “refused to negotiate with us during that entire time when government was open.”

The House voted mostly along party lines in mid-September to approve a seven-week stopgap spending bill that has since stalled in the Senate, leading to the shutdown.

The upper chamber, where major legislation needs at least 60 votes to advance, is set to vote again Friday to try to advance Republicans’ short-term government funding bill, though it’s unlikely to move forward amid the stalemate.  

Many of those polled knew little about shutdown debate 

The KFF poll looked at public knowledge and understanding about the enhanced tax credits for ACA Marketplace health insurance plans, finding 61% of respondents knew nothing or only a little about the issue. 

Another 32% of those surveyed said they know some about the policy debate and 7% said they know a lot. 

The poll of 1,334 adults took place Sept. 23 to Sept. 29 and has a margin of error of plus or minus 3 percentage points for a full survey. Each political affiliation question has a margin of error of plus or minus 6 percentage points.

The government shutdown began on Oct. 1, just after the poll wrapped. 

Concern about the ramifications of letting the enhanced tax credits expire fluctuated when KFF asked the question in different ways, though those who said they were “very concerned” never dipped below a majority. 

Fifty-six percent were very concerned and 30% were somewhat concerned when told “health insurance would be unaffordable for many people who buy their own coverage” if the enhanced tax credits weren’t extended. 

The number of people who would be very or somewhat concerned was high among Republicans, 78%, and MAGA supporters, 76%. 

Respondents who were very concerned rose to 60% when told “about 4 million people will lose their health insurance coverage” if they do not keep receiving the enhanced credits. An additional 26% said they were somewhat concerned and 10% said they were not too concerned, with the rest of those polled saying they were not concerned at all. 

When broken down by political party, the number of people very or somewhat concerned remained high, with 76% of Republicans and 73% of MAGA supporters citing worry. 

Small business staff, self-employed people

Fifty-one percent of those polled said they were very concerned when told “millions of people who work at small businesses or who are self-employed would be directly impacted as many of them rely on the ACA marketplace.”

Another 33% said they were somewhat concerned, 11% said they were not too concerned and the remainder said they were not concerned at all. 

Seventy-five percent of Republicans and 72% of MAGA supporters responded they would be very or somewhat concerned when asked that question. 

The poll showed that Congress extending the enhanced tax credits as they exist now comes with some trepidation about the price tag. 

When asked how concerned people would be if they heard “it would require significant federal spending that would be largely paid for by taxpayers,” 27% said they would be very concerned, 36% somewhat concerned, 28% not too concerned and 8% not at all concerned. 

Forty-one percent of Republicans said they would be very concerned, with another 41% responding they would be somewhat concerned. An additional 15% said they would be not too concerned with the rest saying they were not concerned at all.