Here’s Why 4 Million Americans May Lose Health Insurance Coverage in 2026

If you ask the average American, they’re likely to tell you their health care coverage is already too expensive. According to our data, some 74% of Americans are worried about rising health insurance costs.

And following Trump’s victory in the 2024 presidential election, those Americans may have even more to worry about: Subsidies that allow millions of people to afford health insurance through the ACA marketplace (also known as Obamacare) are set to expire in 2025, and experts say it’s unlikely that Trump will extend them.

How Trump’s victory could change the price of health insurance

While Trump’s specific plans for the United States’ health insurance system remain to be seen, during his first presidency, he supported Republicans’ failed efforts to repeal and replace Obamacare, as well as the American Health Care Act, which would have cut funding to the Prevention and Public Health Fund, as well as federal funding for organizations like Planned Parenthood. (The bill failed in the Senate.)

Around 45 million Americans are currently covered by an Obamacare plan — a figure that’s risen by 14.1 million since 2021. That’s also the year the Biden administration issued the American Rescue Plan, which enhanced the subsidies that help many Americans afford a plan through the ACA marketplace. These enhanced subsidies were extended through 2025 by the Inflation Reduction Act. Health policy source KFF estimates that the enhanced subsidies have lowered premium payments by about 44% — $705 per year — for those who receive them.

If Trump chooses not to extend the enhanced subsidies after they expire in 2025, premiums could rise substantially in 2026 for most enrollees. In fact, KFF estimates that the average premium would be at least twice what it is today in 12 states covered by plans available at healthcare.gov.

For many, such a shift would turn health insurance from a financial strain into an impossibility. The Congressional Budget Office estimates that about 4 million Americans will lose their coverage in 2026 if the enhanced subsidies aren’t extended.

Keeping your coverage affordable — no matter who’s in the White House

There’s good news in the short term: If you receive an ACA subsidy, unless your income changes substantially, you’re likely to continue to receive it through the end of 2025. (However, the overall cost of health insurance does tend to increase each year, so your actual monthly payment may still rise slightly.)

If you need coverage, open enrollment is going on right now, and you can shop for plans on the marketplace through Dec. 15 for Jan. 1 coverage. If you already have coverage, you may be eligible to shop for coverage later through a special enrollment period if you have a major life change (such as losing your job or getting married).

Shopping around for the best health insurance company can make a big difference in the amount of coverage you get for the money you spend. Buying the most affordable health care coverage might save you as much as $100 per month.

Finally, do what you can to prevent the need for expensive doctor’s visits. While anyone can become ill regardless of their behaviors, eating well, exercising regularly, getting enough sleep and protecting your mental health are all relatively low-cost ways to stack the odds in your favor.