The number of people enrolling in health plans through the Affordable Care Act's HealthCare.gov website has fallen in 2026, according to the federal government. (Getty Images)

After a record number of Wisconsin residents signed up for health insurance through the federal health care marketplace in 2025,  enrollment for 2026 is down by 7%, according to the federal government.

Enrollment could fall farther, if people who have signed up decide they can’t afford the cost when the first bill for insurance arrives, an independent analyst warns.

Health insurance — whether purchased through the federal marketplace or elsewhere — is costing people more in 2026. The price of plans purchased through the HealthCare.gov marketplace has gone up. In addition, enhanced federal tax subsidies that became available in 2021 and dramatically lowered the cost for most marketplace customers have expired.

The Affordable Care Act, enacted in 2010, created HealthCare.gov to help reduce the number of Americans without health insurance. The marketplace was designed to make it easier and more affordable for people without health coverage through an employer or through government programs to purchase a health plan for themselves and their families.

After enhanced tax-credit-based subsidies were enacted in 2021, enrollment through the marketplace began setting new records each year, nationally and in Wisconsin. Several efforts by Democrats in Congress last year to extend the subsidies past their Dec. 31, 2025, expiration date failed when the Republican majorities in both houses of Congress declined to take up the proposals.

Legislation that would revive the enhanced subsidies for another three years has now passed the U.S. House, but its future in the U.S. Senate remains uncertain.

“Without the subsidies — that’s what makes it really affordable — many small business owners and others would not have access to health care,” U.S. Rep. Mark Pocan (D-Black Earth) said during a media call in January with Protect Our Care and Main Street Alliance.

Protect Our Care campaigns for preserving and improving the Affordable Care Act and other federal health care programs. Main Street Alliance is a small business organizing group that supports the ACA along with the act’s provision to expand Medicaid by raising the income cap to 138% of the federal poverty guideline.

“We need to keep the Affordable Care Act in place, and the only way you keep it in place so it’s affordable for small business owners and many others is by having those credits,” Pocan said.

Data released last week by the Centers for Medicare & Medicaid Services showed that 291,336 Wisconsin residents had enrolled in plans through HealthCare.gov by Jan. 15, the final open enrollment deadline. That is about 7.1% below 2025 enrollment of 313,579 for the state.

Nationally, 2026 enrollment fell by 1.3 million from 2025, a drop of more than 5%.

Difficult choices for HealthCare.gov customers

For Sydney Badeau, an advocate for people with disabilities, affordable insurance through HealthCare.gov made it possible for her to work part-time for two different Wisconsin advocacy groups. In 2026, that has changed.

Badeau calculated that her 2026 premium would cost her around $450 a month — more than she could afford. She told the Wisconsin Examiner she was able to shift her work arrangement, taking a full-time position with one of her employers, The Arc Wisconsin, which now provides her health benefits, while remaining as a part-timer for her other employer, People First Wisconsin.

Most health plans sold at HealthCare.gov are classified Gold, Silver or Bronze based on a combination of their coverage, premium cost and the out-of-pocket costs that patients incur.

Nancy Peske, a Milwaukee-area freelance writer, editor and consultant, said she has always purchased a bronze plan with a $7,500 deductible. Thanks to the enhanced subsidy, her insurance cost her $370 a month in 2025, she said, instead of about $900 a month.

For 2026, her premium has risen to $1,164 a month — with no subsidy any more.

Peske has stopped contributing to her retirement account. “It will probably push back retirement for a couple of years for me,” she said.

Amanda Sherman, a Mequon real estate broker’s assistant, purchased a mid-level Silver plan in 2025 with a $7,500 deductible. Enhanced subsidies reduced her monthly premium by about $250, to $222 a month.

The health plan also helped cover some expensive medications for her complex autoimmune disorder, Sherman said.  

For 2026 she wound up with a Bronze plan that has a $9,500 deductible. Although she no longer has an enhanced subsidy, she does qualify for a smaller subsidy that still exists, of about $185 dollars — lowering her premium that would have been $538 a month to $353 a month — $120 more than she was paying in 2025.

When she went to enroll for 2026, Sherman’s previous insurer had left the HealthCare.gov marketplace where she lived. In picking a replacement plan, she said, she found herself having to choose between an option with better coverage for her medications — or one that included the same providers and specialists she had grown to trust.

Making that choice was a struggle, but keeping that care team was important, she decided. “I feel like that’s invaluable,” Sherman said.

Enrollment could fall off further

Nationally and in Wisconsin, the total HealthCare.gov enrollment numbers could still shrink further, according to Charles Gaba, an independent researcher who monitors enrollment and coverage under the Affordable Care Act.

In addition to monitoring open enrollment data at his website, acasignups.net, Gaba regularly posts information on a number of other data points. One of those is “effectuated enrollment” — active coverage for which the person enrolling has paid the monthly premium. Effectuated enrollment data lags by several months.

In a post Jan. 29, Gaba wrote that “it’s important to remember that up to 10 MILLION of the [approximately] 19.6M enrollees who re-enrolled did so by passively auto-renewing, which means millions of them received massive sticker shock when they received their January invoice.”

Gaba told the Wisconsin Examiner that for Wisconsin — which uses the federal HealthCare.gov marketplace rather than standing up its own state marketplace — the first batch of effectuated enrollment data might not be available until July at the earliest.

In the Jan. 29 post, however, Gaba wrote that in states with their own marketplaces, “at least a half-dozen of the state-based exchanges have warned that they’re already seeing much higher cancellations than they usually do, and that they expect this trend to continue as people are no longer able to keep up with the dramatically higher premium payments.”

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A patient registers for care at a mobile dental and medical clinic in August 2025. Nationwide, the number of people buying health plans on Obamacare insurance marketplaces is down by about 833,000 compared with a year ago, according to state and federal data. (Photo by Spencer Platt/Getty Images)

Nationwide, the number of people buying health plans on Obamacare insurance marketplaces is down by about 833,000 compared with a year ago, according to federal data released this week.

Many states are reporting fewer new enrollees, more people dropping their coverage, and more people choosing cheaper and less generous health insurance plans with higher deductibles.

Across most states, Thursday was the last day to enroll for plans that start in February. But nine states and Washington, D.C., have deadlines later this month, so the numbers could change.

There are 21 states with state-run health insurance marketplaces, and the rest use the federal website. The vast majority of states have seen declines in enrollment so far, compared with around this time last year.

Preliminary data released Monday by the federal Centers for Medicare & Medicaid Services shows 22.8 million enrollees, down from a record total of 24.3 million last year.

Premiums have surged as a result of the expiration of enhanced federal subsidies first made available by the American Rescue Plan Act in 2021 and later extended through the end of 2025 by the Inflation Reduction Act. The availability of the subsidies spurred a sharp increase in the number of people buying health plans on the marketplaces. In 2020, 11.4 million people were enrolled in marketplaces through Obamacare, formally known as the Affordable Care Act. More than double that amount enrolled last year.

Congress failed to reach an agreement on extending the subsidies before the end of last year and still hasn’t reached one. As a result, premiums were expected to increase this year by 114% on average — from $888 last year to about $1,904, according to estimates made in September by health policy research organization KFF.

The higher costs appear to be driving many people to forgo insurance or opt for cheaper, less generous plans this year, health officials and analysts say. Several states with state-based marketplaces — including Georgia, Illinois, Minnesota, New York, Vermont, Virginia and Washington — are reporting fewer enrollments this year in comparison with enrollments through early January 2025, according to early data. Other states, such as California, are reporting fewer new enrollees.

“It’s important to consider that this is preliminary data, so this represents people who have signed up and selected the plan — but they probably haven’t received their first premium bill,” said Elizabeth Lukanen, executive director of the health policy research organization State Health Access Data Assistance Center at the University of Minnesota. “Once that happens, I think there’s concern — and it seems very possible — that people may decide to drop coverage. So, the decline could get bigger.

“On the other hand, open enrollment hasn’t closed, so you have two things sort of competing. It seems pretty likely that there will be a decline,” she said.

If the downward trend continues, the nation could see the first decline in enrollment since 2020, Lukanen said, adding that a full picture of income levels and demographics of people who have dropped coverage won’t be clear until the summer.

In Pennsylvania, data updated through Tuesday shows more than 15,000 previously enrolled adults between the ages of 55 and 64 have dropped coverage entirely — the most of any age bracket.

Pennsylvania’s state-based exchange, Pennie, has seen about 15% fewer new enrollments compared with last year. The state is also reporting 1,000 residents dropping coverage per day during open enrollment — with the most coverage losses among people with incomes 150% to 200% of the poverty level. These could include families of two adults and two children with an income between $48,225 and $64,300.

The state is seeing an “unprecedented” number of previously enrolled people dropping coverage, said Devon Trolley, executive director of the Pennsylvania Health Insurance Exchange Authority.

California is reporting 31% fewer new enrollees this year compared with last year, and more than a third of new enrollees are choosing bronze plans — the lowest, least generous coverage tier — up from less than a quarter at this time last year.

In Minnesota, data as of Dec. 3 shows more than half of active enrollees are opting to keep their coverage tier. But of those changing plans, more than a third — 37% — are going to cheaper plans. The state notes a full picture won’t be available until March.

Meanwhile, some states are seeing roughly the same number of enrollees or more. Texas, for example, is reporting about 4.1 million people enrolling this year compared with 4 million last year.

Charles Miller, health and economic mobility policy director at Texas 2036, a policy research nonprofit, said it’s unclear why enrollments are up, but pointed to some clues.

“Texas had a uniquely large population of uninsured individuals eligible for free and inexpensive plans that hadn’t enrolled previously … [and] has more affordable bronze and gold plans than many states,” he said.

He attributes that to a bipartisan state law, enacted in 2021, that had the effect of increasing subsidies for those plans, Miller said.

Nevada is seeing fewer enrollees overall. But compared with this time last year, the state is seeing 29% more people who are actively shopping the website to explore plans, said Katie Charleson, communications officer at the Nevada Health Authority Division of Consumer Health Services.

The state introduced a new public option, according to the Nevada Current, and health officials told lawmakers last week that about 1 in 5 active shoppers are opting for that plan.

In addition to the expiration of the subsidies, the cost of coverage has risen because of other factors, according to insurers. They say they’ve had to raise premiums because of rising prescription drug costs, inflation and workforce challenges, such as provider shortages.

But the enhanced premium tax credits were aimed at buffering those year-to-year changes for Americans with lower incomes, said Trolley, adding that the tax credit structure “helps make sure that [enrollees] don’t see those really larger drops that happen from time to time, sort of from those market forces.”

“When there are broader rate increases of … the total cost of the coverage, the tax credits are structured so that people who get a tax credit don’t feel a lot of that increase. They’re sort of sheltered from it on a year to year basis,” Trolley said. “The tax credit is tied to someone’s income and limits what they pay as part of their income, not necessarily tied to the cost of the coverage.”

She added that she’s also heard from some residents who say they are waiting to enroll in a plan to see if Congress takes action.

“People are leaving the ACA marketplace because the trade-offs have just become harder to justify,” Lukanen said. “What worries me is that when the coverage becomes unaffordable, it isn’t that people suddenly stop needing care. They just lose the protection that insurance offers, and those health care costs don’t go away.”

Lukanen added that if more people forgo coverage, health care services may end up costing the nation more overall.

“If people are going to the doctor and they don’t have insurance, these costs are then just shifted. They’re shifted to hospitals, ultimately to the community and the taxpayer.”

Trolley echoed that, saying she’s concerned about the overall burden on providers in rural counties, which are seeing the highest drops in Obamacare coverage in Pennsylvania.

“Any increase in the uninsured rate is going to further strain providers that are in rural areas, especially — further strain their financial situation,” she said. “We are very concerned about that in Pennsylvania.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

(Getty Images)

This article first appeared on KFF Health News.

As Congress debates whether to extend the temporary federal subsidies that have helped millions of Americans buy health coverage, a crucial underlying reality is sometimes overlooked: Those subsidies are merely a band-aid covering the often unaffordable cost of health care.

California, Massachusetts, Connecticut and five other states have set caps on health care spending in a bid to rein in the intense financial pressure felt by many families, individuals and employers who every year face increases in premiums, deductibles and other health-related expenses.

Hospitals and other health care providers are citing Republicans’ One Big Beautiful Bill Act, signed by President Donald Trump in July, as one more reason to challenge those limits.

The law is expected to reduce federal Medicaid spending by more than $900 billion over a decade, which mathematically should help the overall health care system meet the caps. But the law is also expected to increase the number of uninsured Americans, mostly Medicaid beneficiaries, by an estimated 10 million people. Health care analysts predict hospitals and other providers will raise prices to cover the double whammy of lost Medicaid revenue and the cost of caring for an influx of newly uninsured patients.

Whether regulators in some states will allow providers to justify higher prices and exceed the spending caps is unclear. Only California and Oregon can penalize providers financially if they fail to meet targets.

“Are we going to say, ‘That’s OK’? Or are we going to say, ‘Well, you exceeded the target. We’re still going to penalize you for that’?” said Richard Pan, a former state lawmaker and a member of the California Office of Health Care Affordability’s board. “That has not yet been decided.”

The California Hospital Association, the industry’s main state lobbying group, filed a lawsuit in October asking a state court to strike down the spending caps, which it argued fail to account for all the cost pressures hospitals face. Those pressures, it said, include an aging, sicker population; the rising cost of labor; expensive advances in medical technology; large capital outlays on required seismic retrofitting; and changes in federal policy, including the One Big Beautiful Bill Act. The hospital group’s lawsuit also asserted that the state affordability office, by hastily imposing ill-considered cost-cutting targets, was undermining its other key mission of improving health care access, quality and equity.

California’s affordability office last year set a five-year target to cap statewide spending growth, starting at 3.5% in 2025 and declining to 3% by 2029. The annual caps apply to a wide range of health care entities, including hospitals, medical groups, insurers and other payers.

Earlier this year, it imposed much lower spending growth caps — starting at 1.8% in 2026 and declining to 1.6% by 2029 — for seven “high-cost” hospitals.

“The spending caps set by politically appointed bureaucrats could force cuts that result in many Californians traveling farther for care, facing longer emergency room wait times, experiencing more overcrowding and losing access to critical services,” Carmela Coyle, the hospital association’s president and CEO, said in an October press release.

The California attorney general’s office, which will represent the affordability agency, has not yet filed a response to the hospital group’s complaint and did not respond to a request for comment.

Hospitals’ pushback

California is not the only state taking a close look at hospital prices, which are widely considered a primary driver of health care costs.

“States, armed with information that points to payments to hospitals as a driver of what is way beyond affordable commercial premiums, have begun to take increasingly targeted actions focused on commercial hospital prices,” said Michael Bailit, founder of the Needham, Massachusetts-based consultancy Bailit Health, which has advised multiple states, including California, on ways to tame health care spending. “It is not surprising that the hospital industry is going to oppose such state actions.”

In its lawsuit, the California Hospital Association said the affordability office’s own report showed that pharmaceutical and insurance companies are largely responsible for high costs.

Hospitals in some states with cost growth limits, including Connecticut and Massachusetts, have expressed objections similar to the ones raised in the California lawsuit. They could follow their counterparts in California if their lawsuit succeeds, said Peter Lee, who led California’s Affordable Care Act marketplace, Covered California, for over a decade and is now a senior scholar at Stanford Medicine’s Clinical Excellence Research Center.

Lee said the work of California’s affordability office and similar agencies in other states is just about the only systemwide effort being made to cut health care costs. They are basically saying, “‘Look, health care is taking money away from education, it is taking money away from the environment, it is taking money away from everything in the public sector, and in the private sector it is taking money away from wages,’” he said. “‘We don’t know how you, the health system, are going to do it, but it is your job not just to provide quality but to lower costs. Here’s the target.’”

To be sure, achieving the cost savings that California and those other states are seeking is no easy lift. It will ultimately require persuading large, financially powerful players that compete fiercely for health care dollars to adopt a different mindset and begin cooperating to reduce costs instead. And that, in many cases, will mean lower revenue.

But the status quo, as many people know all too well, means continued financial pain for millions.

In early 2020, Estevan Rodriguez, a bartender at California’s Monterey Beach Hotel, had surgery for a staph infection in his leg. The bill came to nearly $168,000. His insurance paid most of it, but he still owed $5,665, which took him two years to pay, more than $200 every month. “It may not be a lot to some people, but it was a lot to me,” Rodriguez said.

He said he dropped his Hulu subscription, switched to a lower-cost cellphone, and got cheaper car insurance. He started going to food banks rather than the grocery store, he said, and had a lot less time with his kids, because he was constantly working to pay off the hospital bill.

Community Hospital of the Monterey Peninsula, where Rodriguez had his surgery, is one of the seven hospitals identified by California’s affordability office as high-cost. A study by the office attributed high hospital prices in Monterey County to a lack of market competition “rather than higher operating costs or superior quality of care.”

The Monterey hospital referred a request for comment about its “high-cost” designation to the California Hospital Association. CHA spokesperson Jan Emerson-Shea declined to comment beyond the language of the lawsuit and Coyle’s press release statement.

Reduced competition

Health care analysts worry the One Big Beautiful Bill Act will reduce market competition even further by stressing already weak hospitals, leading some to shut services, merge with larger health systems, or close. One study estimates 338 rural hospitals are at risk of closing nationwide.

Less competition, in addition to fewer Medicaid dollars and an increase in uninsured patients, will only strengthen the incentive of health systems with the requisite market clout to raise their commercial prices, increasing premiums for employers and individuals.

“We think commercial prices will continue to increase as health care providers, and hospitals in particular, will seek to preserve or increase their revenue,” said Rachel Block, a program officer at the Milbank Memorial Fund, a foundation that focuses on health equity.

That in turn could pose a challenge to state affordability regulators tasked with overseeing compliance with growth targets for health care spending.

California’s affordability office is required to consider mitigating factors, including changes in federal and state laws. But some of its board members have expressed skepticism about letting hospitals offset Medicaid losses with higher commercial prices.

“There’s a lot of talk about using HR 1 and other federal policies as an excuse to raise prices on commercial payers,” Ian Lewis, an affordability office board member and policy director for UNITE HERE Local 2, a hospitality workers union in the Bay Area, said at the agency’s July board meeting, referring to the One Big Beautiful Bill. “There’s no more blood to be squeezed from this stone.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.

U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured are, from left, Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republicans released a health care bill Friday evening they hope will help curb rising costs, though the measure doesn’t have the level of Democratic support needed to get through the Senate. 

The 111-page bill will likely move to the House floor next week, where Speaker Mike Johnson will need nearly every one of his members to vote to pass the legislation, an uphill battle given the vastly different views among centrists and far-right members of the party on health care issues. 

The Louisiana Republican said in a statement the bill offers “clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans.”

Democrats have been pressing for a three-year extension of the enhanced tax credits for people who purchase their insurance through the Affordable Care Act marketplace. 

So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. 

GOP lawmakers have instead pursued their own legislation, but without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdles. 

Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. 

Democrats were also unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years. 

The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress over the rising cost of health insurance and health care, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections. 

Targeting ‘real drivers’ of cost increases

Johnson rebuked Democrats in his statement for enacting the Affordable Care Act during President Barack Obama’s first term, saying the law hasn’t made health care cost less. 

House Republicans’ new legislation, Johnson said, will address “the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans.”

The bill would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

The House Rules Committee is scheduled to prepare the bill for floor debate on Tuesday by considering whether to allow any amendments to be considered on the floor. 

The full House will then debate the legislation later in the week before departing for the two-week holiday break. 

Trump wants direct payments

President Donald Trump, speaking from the Oval Office shortly after the bill was released, reiterated his preference that the federal government send payments directly to Americans.

“We want to give the money to the people and let the people buy their own great health care, and they’ll save a lot of money, and it’ll be great,” he said.

But Trump also appeared to signal he is going to stay out of negotiations in Congress, saying, “I leave it to them and hopefully they’re going to put great legislation on this desk right here.”

Senate Majority Leader John Thune, R-S.D., center, joined by Senate Majority Whip John Barrasso, R-Wyo., left, and Sen. James Lankford, R-Okla., speaks to reporters following a Senate Republican policy luncheon at the U.S. Capitol on Dec. 9, 2025 in Washington, D.C.  (Photo by Heather Diehl/Getty Images)

WASHINGTON — The U.S. Senate in long-anticipated votes failed to advance legislation Thursday that would have addressed the rising cost of health insurance, leaving lawmakers deadlocked on how to curb a surge in premiums expected next year. 

Senators voted 51-48 on a Republican bill co-sponsored by Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027. 

They then voted 51-48 on a measure from Democrats that would have extended enhanced tax credits for people who purchase their health insurance from the Affordable Care Act Marketplace for three years. A group of Senate Democrats in November agreed to end a government shutdown of historic length in exchange for a commitment by Republicans to hold a vote on extending the enhanced subsidies.

Republican Sens. Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska voted for the Democrats’ bill. Sen. Rand Paul, R-Ky., voted against both bills. 

Neither bill received the 60 votes needed to advance under the Senate’s legislative filibuster rule. 

Senate Majority Leader John Thune, R-S.D., criticized the ACA marketplace and the subsidies for leading to large increases in the costs of health insurance. 

“Under Democrats’ plan insurance premiums will continue to spiral, American taxpayers will find themselves on the hook for ever-increasing subsidy payments,” Thune said. “And don’t think that all those payments are going to go to vulnerable Americans.”

Thune argued Democrats’ bill was only an extension of the “status quo” of a “failed, flawed, fraud program that is increasing costs at three times the rate of inflation. 

Thune said the Republican bill from Cassidy and Crapo would “help individuals to meet their out-of-pocket costs and for many individuals who don’t use their insurance or who barely use it, it would allow them to save for health care expenses down the road.”

Schumer calls GOP plan ‘mean and cruel’

Senate Minority Leader Chuck Schumer, D-N.Y., said the three-year extension bill was the only option to avoid a spike in costs for people enrolled in ACA marketplace plans. 

“By my last count, Republicans are now at nine different health care proposals and counting. And none of them give the American people the one thing they most want — a clean, simple extension of these health care tax credits,” Schumer said. “But our bill does extend these credits cleanly and simply and it’s time for Republicans to join us.”

Schumer referred to the Cassidy-Crapo proposals as “stingy” as well as “mean and cruel.”

“Under the Republican plan, the big idea is essentially to hand people about $80 a month and wish them good luck,” Schumer said. “And even to qualify for that check, listen to how bad this is, Americans would be forced onto bare-bones bronze plans with sky-high deductibles; $7,000 or $10,000 for an individual, tens of thousands for a couple.”

After the votes failed, Schumer outlined some of the guardrails Democrats would put in place regarding negotiations with GOP colleagues.

“They want to talk about health care in general and how to improve it — we’re always open to that, but we do not want what they want — favoring the insurance companies, favoring the drug companies, favoring the special interests and turning their back on the American people,” he said. 

Health Savings Accounts in GOP plan

The Cassidy-Crapo bill would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill. 

Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.

ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64. 

That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.  

The funding could not go toward abortion access or gender transitions, according to the Republican bill summary. 

Members of Congress have introduced several other health care proposals, including two bipartisan bills in the House that would extend the enhanced ACA marketplace tax credits for at least another year with some modifications. 

Speaker Mike Johnson, R-La., has been reluctant to bring either bipartisan bill up for a floor vote, though he may not have the option if a discharge petition filed earlier this week garners the 218 signatures needed. 

Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”

“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”

But Johnson said Wednesday that he will put a package of bills on the House floor next week that he believes “​​will actually reduce premiums for 100% of Americans who are on health insurance.” Details of those bills have not been disclosed.

Thune told reporters that if “somebody is successful in getting a discharge petition and a bill out of the House, obviously we’ll take a look at it. But at the moment, you know, we’re focused on the action here in the Senate, which is the side-by-side vote we’re going to have later today.” 

Alaska’s Murkowski said lawmakers can find a compromise on health care by next week “if we believe it is possible.”

Political costs

The issue of affordability and rising health care costs is likely to be central to the November midterm elections, where Democrats hope to flip the House from red to blue and gain additional seats in the Senate. 

The Democratic National Committee isn’t waiting to begin those campaigns, placing digital ads in the hometown newspapers of several Republicans up for reelection next year, including Maine’s Collins and Ohio’s Jon Husted. 

“Today’s Senate vote to extend the ACA tax credits could be the difference between life and death for many Americans,” DNC Chair Ken Martin said in a press release. “Over 20 million Americans will see their health care premiums skyrocket next year if Susan Collins, John Cornyn, Jon Husted, and Dan Sullivan do not stand with working families and vote to extend these lifesaving credits.”

White House press secretary Karoline Leavitt blasted Senate Democrats’ proposal during Thursday’s press briefing, calling it a “political show vote” meant to provide cover for Democrats, whom she blamed for creating the problem. 

Trump and Republicans would “unveil creative ideas and solutions to the health care crisis that was created by Democrats,” she said. “Chuck Schumer is not sincerely interested in lowering health care costs for the American people. He’s putting this vote on the floor knowing that it will fail so he can have another talking point that he can throw around without any real plan or action.”

Shauneen Miranda and Jacob Fischler contributed to this report. 

U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured from left are Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Speaker Mike Johnson committed Wednesday to hold a vote next week on a package of bills that he said would lower health insurance premiums for hundreds of millions of Americans, not just those enrolled in Affordable Care Act plans. 

But the Louisiana Republican’s promise didn’t come with any details about which bills would be included in the package or whether the legislation will have the GOP votes needed to pass, amid vastly different views among his members about the federal government’s role in health care. 

“You’re going to see a package come together that will be on the floor next week that will actually reduce premiums for 100% of Americans who are on health insurance,” Johnson said. 

That will be a challenging task for Johnson and other House Republican leaders since they hold an especially narrow 220-213 majority. Democrats are unlikely to support GOP bills that don’t extend the enhanced tax credits for people who buy their health insurance through the ACA marketplace. Without the tax credit subsidies, costs are expected to rise sharply.

House Majority Leader Steve Scalise, R-La., said just after a closed-door meeting of House GOP lawmakers on health care that leaders were still finalizing which bills would go into the package. 

“We showed a list of what the three committees of jurisdiction have been working on for months today. And then encouraged all the members to give their feedback. And they did,” Scalise said. “A lot of members spoke today at the mic, which we want. They gave their feedback. And frankly, a lot of it was very positive about those bills.”

Senate votes Thursday

The House bills are part of a larger debate in Congress and at the White House about the rising cost of living, including health care affordability, that surged to the forefront in October and November after Democrats shut down the government. 

Senate Democrats throughout the six-week shutdown demanded a vote to extend the enhanced ACA marketplace tax credits, which are set to expire at the end of the year.

Senate Majority Leader John Thune, R-S.D., promised Democrats a floor vote on a health care bill of their choosing in exchange for votes to end the shutdown. 

The Senate is expected to vote Thursday on a Democratic bill that would extend enhanced ACA marketplace tax credits for three years.

The nonpartisan Congressional Budget Office estimates that proposal would increase the federal deficit by $83 billion during the next decade. 

That three-year extension would boost the number of people with health insurance by 400,000 in 2026, 3 million in 2027, 4 million in 2028, and 1.1 million in 2029, compared to current law. 

Senators will also vote Thursday on legislation from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo, both Republicans, that would provide up to $1,500 annually for people who buy either bronze or catastrophic health insurance plans from the ACA marketplace.

The funding would go directly into a Health Savings Account for people between the ages of 18 and 64 who make up to 700% of the federal poverty level. That would be about $109,550 for one person or $225,050 for a family of four. The funding would last for 2026 and 2027 but end after that. 

Neither proposal is expected to get the 60 votes needed to advance under the Senate’s legislative filibuster rule. Even if a bill moved through the Senate, it would still need to get a House vote, a prospect that seemed like a long shot now that House GOP leaders are putting out a package of their own. 

Abortion coverage

South Carolina Republican Rep. Ralph Norman said after the conference meeting that “the devil’s in the details” of exactly which bills go to the floor but added GOP lawmakers had begun to form a “consensus.”

Maryland Republican Rep. Andy Harris said he doesn’t believe GOP lawmakers are responsible for addressing any aspect of the Affordable Care Act, including the expiring tax credits. 

“It’s not our responsibility to fix Obamacare,” Harris said. “They broke it. They should fix it.”

Harris, chairman of the far-right Freedom Caucus, said he wouldn’t support any bill to extend the enhanced ACA marketplace tax credits unless it restricted abortion access in those health insurance plans to only cases of rape, incest, or the life of the pregnant patient. 

That issue has become a central negotiating point for many GOP lawmakers, even those who are open to extending the tax credits a little while longer. 

‘Moment of truth’

Democrats argue adding those constraints, often referred to as the Hyde Amendment, is unacceptable and would represent a new restriction on abortion access. 

“I don’t understand when you’ve had a number of Republicans in the House and the Senate say they get it, this is a disaster to have these premiums double and triple, why they want to mess around right now and put abortion politics into the middle of this,” Minnesota Democratic Sen. Amy Klobuchar said. “They know that that’s not going to work.”

Senate Minority Leader Chuck Schumer, D-N.Y., said the only proposal on the table to extend the enhanced ACA marketplace tax credits, avoiding a surge in premiums next year, is the Democratic bill. 

“Tomorrow is a moment of truth for the Republicans here in the Senate,” Schumer said. “Are they going to bring health care costs down, or will they sit by and let premiums explode for millions of Americans?”

Discharge petition on bipartisan bill

Later in the day a potential solution emerged when a bipartisan group of House lawmakers filed a discharge petition that would force a floor vote on their compromise bill if they can get at least 218 signatures. 

Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”

“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”

The 79-page bill, formally titled the Bipartisan Health Insurance Affordability Act, is co-sponsored by Nebraska Republican Rep. Don Bacon, Pennsylvania Republican Rep. Rob Bresnahan, North Carolina Democratic Rep. Donald Davis, Washington state Democratic Rep. Marie Gluesenkamp Perez, Maine Democratic Rep. Jared Golden, New York Republican Rep. Nicole Malliotakis and New York Democratic Rep. Tom Suozzi. 

The legislation would extend enhanced ACA marketplace tax credits through 2027 and expand access to Health Savings Accounts, among several other changes.

Golden wrote in a statement announcing the bill’s introduction Tuesday that it “implements sensible income caps” on who can receive the ACA marketplace tax credits.

“This moment requires leaders to abandon their partisan corners and govern,” Golden wrote. “Our bill provides a path out of gridlock and toward solutions.”

Gluesenkamp Perez wrote that no one “wants to shell out more cash to insurance companies or (pharmacy benefit manager) middlemen.”

“At the same time, we can’t lose sight of the fact that national health doesn’t come from insurance coverage — it hinges on people having good jobs, being able to sleep 8 hours a night, cook real food and see their kids at night,” she added. “Affordable healthcare and medicine are imperative and worth the fight, but a strong nation is longer work.”

Jacob Fischler contributed to this report.

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The amount some pay for Affordable Care Act health insurance will double when enhanced subsidies expire, but there isn’t evidence the number is 20 million.

KFF, a health policy nonprofit, estimates monthly payments for Obamacare recipients will increase, on average, $1,016 – more than doubling, from $888 in 2025 to $1,904 in 2026.

That counts increases to premiums and lost subsidies.

U.S. Sen. Bernie Sanders, I-Vermont, citing KFF, made the 20 million claim. U.S. Sen. Ron Johnson, R-Wis., said Sanders was wrong.

KFF doesn’t say how many of the 24 million Obamacare enrollees will see premiums double.

But 2 to 3 million people on the high end of income eligibility would lose all enhanced subsidies. About half could see premium payments double or triple. 

Enhanced subsidies, created in 2021, expire Dec. 31. Some Obamacare enrollees will receive lower enhanced subsidies or none. Standard subsidies remain.

This fact brief is responsive to conversations such as this one.

Sources

• KFF: ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire
• U.S. Sen. Bernie Sanders: Email
• KFF: Email
• Centers for Medicare & Medicaid Services: Health Insurance Exchanges 2025 Open Enrollment Report
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• NBC News: What the government shutdown's end means for Obamacare subsidies
• PolitiFact: Fact-checking Democrats’ talking points about Affordable Care Act subsidies

Will 2026 Obamacare premiums double for 20 million Americans? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.