The government shutdown has ended, but Senate Democrats didn’t get a key provision they were fighting for: extending the Obamacare tax credits that are set to expire at the end of the year.
The credits, also referred to as enhanced subsidies, have kept health care premiums affordable for millions of Americans.
Open enrollment for 2026 coverage is well underway, and people who get their insurance through the Affordable Care Act have seen how much their costs will rise without the subsidies — many could see their monthly premiums double or even triple. Some may delay signing up, hoping lawmakers intervene before year’s end, while others could forgo coverage altogether.
“In some respects, the damage is already done,” said John A. Graves, a professor of health policy and medicine at Vanderbilt University School of Medicine in Nashville, Tennessee. “Premiums are higher in expectation of them expiring and they didn’t get it done in time for open enrollment, so people are seeing these premium increases.”
Here’s what you need to know about what the end of the shutdown means for the ACA's enhanced subsidies.
Is there still a chance the subsidies will get extended?
Yes — but the chances are growing slimmer by the day, Graves said.
In exchange for winning Democratic votes, Senate Majority Leader John Thune, R-S.D., publicly promised to hold a Senate vote on extending the subsidies by the end of the second week of December. He said Democrats can offer any bill they want, but it needs to win the support of 60 senators to pass, meaning at least 13 Republicans.
Even if the bill clears the Senate, it would still need to pass the House and win President Donald Trump’s signature — both far from guaranteed.
Speaker Mike Johnson, R-La., has refused to commit to a vote in the House, and many House Republicans say they want the funds to expire.
An amendment introduced Wednesday by House Minority Leader Hakeem Jeffries, D-N.Y., and other Democrats to extend the subsidies for three more years has been filed as a “discharge petition” to end-run House GOP leaders and get a floor vote, but it’s unlikely to advance.
At minimum, the Republicans who are open to extending the funds have demanded restrictions, including tighter income thresholds and an end to no-premium plans. So one way or another, costs are likely to increase for at least some Americans.
Will it be too late if Congress extends them in December?
No, but people may still have to pay the higher rate, at least for the first month, said Cynthia Cox, director of the program on the ACA at KFF, a nonpartisan health policy research group.
ACA enrollees generally need to sign up by Dec. 15 and make their first payment by late December for coverage to begin on Jan. 1. Those who sign up after Dec. 15 will typically see their coverage start Feb. 1.
“If Congress passed something on Dec. 12, that would probably be too tight of a turnaround time for the people who have their coverage starting Jan. 1,” Cox said. “They would have to make a higher monthly payment and then wait until they file their taxes in early 2027 to get the enhanced tax credit for January 2026.” The monthly payment would shift to the lower rate in February.
There is also a timing issue if the subsidies are extended and people decide to change their policies.
“If people want to make a change to their plan, and they do so after Dec. 15,” Cox said, “then they will probably be enrolled in one plan in January and a different plan, with a different deductible, starting in February.”
Some people may not realize Congress extended them and may not sign up at all.
“There has already been a large cost in terms of how many people will be dissuaded from signing up, and that’s continuing to grow each day,” said Gideon Lukens, a senior fellow and director of research and data analysis on the health policy team at the Center on Budget and Policy Priorities, a nonpartisan research group.
What happens if Congress fails to extend them?
Premiums were already set to rise next year, but without the subsidies they will climb far more sharply, Cox said.
Insurers are increasing premiums by an average of 30% in states that use HealthCare.gov, and by 17%, on average, in states that run their own marketplaces, according to a KFF analysis published in late October.
“In some ways, this is a debate happening six months too late,” Graves said, “because the insurers have already set their rates kind of under the assumption that these may expire. And so, they set rates to reflect the risk pool that they were expecting.”
Combined with the loss of the tax credits, some people could pay 114%, on average, more in premiums, the KFF analysis found.
The Congressional Budget Office, a nonpartisan government group that provides budget and economic information to Congress, projects that each year, 3.8 million people, on average, will drop their coverage and become uninsured over the next eight years.
Keep Americans Covered, a coalition of insurers and health industry groups pushing for an ACA funding extension, warned that “real people will pay a real and devastating price” if Congress fails to act.
What other options do I have?
Should the enhanced subsidies end, anyone earning under four times the federal poverty line — roughly $62,600 for an individual and $128,600 for a family of four — would still be eligible for the standard ACA subsidies, Cox said.
Some people who lose the extra tax break may still be able to cut costs by switching from a silver plan to a bronze plan, which offers a lower monthly bill but comes with a higher deductible.
Others may choose to go uninsured, but experts warn that is a risky option, especially for people with existing health issues.
Republicans are discussing alternatives to the subsidies, but they have no fully fleshed-out plan or internal consensus on how to proceed. Ideas include redirecting the funds to consumers to use in tax-advantaged flexible spending accounts (FSAs) or health savings accounts (HSAs).
KFF health policy expert Larry Levitt said that “it’s hard to tell exactly how these concepts of replacing ACA premium assistance with cash or health accounts would really work in practice.”
