When Eileen Tyrrell logged into the New York State Health Insurance Marketplace in December, her monthly premium had jumped from about $147 to $849.
“It was one of those stomach-churning moments,” said Tyrrell, 26, who was making about $53,000 in 2025 as a bookstore manager in Brooklyn. She expects to earn about $72,000 in 2026, including her bookstore salary and income from creating content on TikTok.
Last year, the federal premium tax credit covered Tyrrell’s monthly premiums of about $510, lowering her out-of-pocket costs on her Affordable Care Act Bronze plan to $147 a month. But between her higher income, higher basic premiums, and the expiration of enhanced pandemic-era subsidies, the same plan could cost hundreds of dollars more per month.
The enhanced subsidies, first expanded in 2021 under the American Rescue Plan Act, removed income limits for financial aid and capped premiums at 8.5% of household income, making more middle-income Americans eligible for aid.
However, Congress did not extend this provision beyond 2025. The premium tax credit can still reduce monthly costs for some Americans, but eligibility is limited to households earning up to 400% of the federal poverty level ($62,600 for a single person in 2025), a cap that was temporarily lifted with the enhanced subsidies.
According to KFF, a nonpartisan health policy research group, enrollees who exceed the cap now have to pay their full premium. That includes Ms. Tyrrell, whose estimated income in 2026 will be about 460% of the federal poverty level, based on KFF’s ACA Market Calculator.
Nationally, the impact is already visible. According to KFF’s March 2026 study, approximately 1 in 10 people who were enrolled in the ACA Marketplace last year are currently uninsured.
And for those keeping their existing plans, costs are rising rapidly. A 2025 analysis by KFF estimates that premium payments will more than double on average for subsidized participants who remain in the same plan after the enhanced tax credit expires.
“The loss of ACA subsidies means the end of already fragile budgets for many people just starting out in their careers and financial lives,” says Cynthia Luna, a Texas-based certified financial planner.
“This just forces people to make harder choices,” she says. “Food or medicine? Medical insurance or savings?”
According to KFF, just over 24 million people selected ACA Marketplace plans in 2026. The Congressional Budget Office estimates that about 2.2 million more people will be uninsured in 2026 than if subsidies had continued to increase, as some people lose coverage or go uninsured due to rising premiums.
Cost savings at the state level
Efforts to restore enhanced federal ACA premium subsidies have stalled in Congress, with no clear path forward in the Senate after negotiations broke down, the Wall Street Journal reported last month. Some states, including New Mexico, California and Maryland, have added state aid to offset some of the increase, according to KFF.
But in most states, including Tyrrell’s home state of New York, middle-income participants face losing all of their enhanced federal aid. Based on KFF’s ACA Market Calculator, single New York residents with incomes of approximately $62,600 or more are no longer eligible for subsidies. By comparison, a single adult without children would need to earn $79,469 a year before taxes to cover the necessities of life in Manhattan, according to the MIT Living Wage Calculator.
These trade-offs are often immediately reflected in household budgets. Luna said some people have been forced to cut back on discretionary spending and savings, while others have cut back on essential expenses or even cut off coverage altogether as costs rise.
“When people start making a little bit of money, they get screwed in a way, because once their income reaches a certain threshold, they no longer have access to the programs that might have kept them afloat,” Tyrrell says.
Instead of paying the increased premiums on the Bronze plan, Tyrrell switched to a $257 per month catastrophic plan. However, the economic risks have not yet disappeared. Her catastrophic plan has a $12,000 deductible, meaning she must pay the first $12,000 out of pocket before most benefits begin.
“Health care is really not something you can control,” Tyrrell said. “You can’t just set a goal of only spending X amount of money each month on medical expenses.”
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