Where ACA enhanced subsidies stand: 14 updates
By Jakob Emerson and Elizabeth Casolo / October 17, 2025
The federal government has shut down for the first time since 2019 after lawmakers failed to reach a funding deal, with the fate of enhanced ACA subsidies, set to expire at year’s end, hanging in the balance.
Premium tax credits were originally available for enrollees making between 100% and 400% of the federal poverty limit. In 2021, the American Rescue Plan Act increased the amount of these tax credits and expanded marketplace eligibility to households with an annual income over 400% of the federal poverty limit, capping out-of-pocket premiums for a benchmark plan at 8.5% of income.
Since the introduction of the enhanced credits, ACA marketplace enrollment has more than doubled from 11.4 million in 2020 to 24.3 million in 2025, according to KFF.
14 subsidies updates:
1. Senate Majority Leader John Thune, R-S.D., told MSNBC Oct. 15 he privately expressed to Democrats that he is open to a vote on the subsidies. “I can’t guarantee it’s going to pass,” he said of a potential bill. “I can guarantee you that there will be a process and you will get a vote.”
2. The GOP has four ideas on how to approach a subsidies compromise, Politico reported Oct. 14. Some lawmakers are in favor of imposing new income caps, minimum out-of-pocket payments, limits specifically on new enrollees accessing tax credits and abortion restrictions.
3. On Oct. 6, Senate Minority Leader Chuck Schumer, D-N.Y., denied President Donald Trump’s claims of bipartisan talks on healthcare, according to Politico.
4. In an Aspen Institute talk, CMS Administrator Mehmet Oz, MD, said both parties will need to join forces amid the “public health emergency” of the government shutdown.
5. Speaker Mike Johnson, R-L.A., said talks on ACA subsidies cannot continue under a government shutdown. “We have to keep the lights on in the building so that we can have those discussions and debates,” he said in an MSNBC interview.
6. Senate Majority Leader John Thune, R-S.D., told Politico on Oct. 1 he would consider negotiating the enhanced tax credits if he sees a “critical mass” of Democrats supporting the current funding bill.
7. Sen. Mike Rounds, R-S.D., proposed a one-year extension of the enhanced tax credits in the final hours before the shutdown, Politico reported. Mr. Rounds did not push for the provision to be linked to the stopgap spending bill, but rather as its own initiative. House GOP lawmakers have proposed similar legislation.
8. On Sept. 29, there was some progress at the White House for Democrats pushing for an extension of the enhanced subsidies, Politico reported. While the Trump administration and Republicans showed willingness to negotiate the subsidies, discussions hinged on keeping the government open first.
9. The Congressional Budget Office has said extending the enhanced subsidies would cost $350 billion and boost the insured population by 3.8 million over the next decade.
10. If the enhanced subsidies are not renewed, the Urban Institute predicts some states will see stark spikes in their uninsured population. Mississippi would be the hardest hit, with 99% of ACA enrollees currently receiving enhanced tax credits. Nationally, around 4.8 million people are estimated to lose coverage.
11. Insurers have requested the highest ACA rate increases this year since 2018, with some rates already approved by state regulators. For 2026, the median proposed premium increase among 318 small group insurers across all 50 states and the District of Columbia is 11%, per KFF.
12. More than 24 million Americans could see their premiums increase by an average of 93% without an extension, according to St. Louis-based Ascension. Meanwhile, KFF estimates that premiums for currently subsidized enrollees would more than double if the tax credits expire, according to an analysis published Sept. 30.
13. Health systems and insurers have been warning that the looming expiration of the enhanced credits is a critical concern. The AHA has said that the loss of the credits will upend emergency departments and worsen provider burnout. More uninsured individuals or those facing higher premiums would likely delay or forgo care, exacerbating health disparities and increasing uncompensated care. That shift could result in a $28 billion reduction in hospital spending over the next decade.
14. In September, CMS expanded eligibility for catastrophic health coverage on the ACA marketplace in 2026 in anticipation of expired enhanced subsidies.