Enrollees in 12 HealthCare.gov states would see their annual payments at least double on average without enhanced subsidies

July 27, 2024 - Without the enhanced subsidies in the Inflation Reduction Act (IRA), Affordable Care Act (ACA) Marketplace enrollees in 12 of the states that use HealthCare.gov would see their annual premium payments at least double on average, according to a new KFF analysis. Enrollees in three states would see the steepest annual increases: Wyoming (195% or $1,872), Alaska (125% or $1,836), and West Virginia (133% or $1,404), and premiums would rise by an average of 93% or $624 overall in HealthCare.gov states.

The results of the 2024 elections will likely play a major role in whether the enhanced subsidies are extended beyond 2025. Nationally, enhanced subsidies have cut premium payments by an estimated 44% ($705 annually) on average for people receiving a subsidy. If they expire, almost all subsidized ACA Marketplace enrollees, including those in state-run marketplaces, would experience steep increases in premium payments in 2026. Because enhanced subsidies have made Marketplace coverage more affordable for low- and middle-income people, they would be the most impacted by a potential subsidy expiration.

Enrollees with low incomes would see the greatest jump in their premium payments. For example, a 45-year-old enrollee earning $25,000 on average would pay 573% ($917) more annually for a benchmark silver plan (from $160 with enhanced subsidies to $1,077 without them).

The number of people with Marketplace coverage nearly doubled since the enhanced subsidies began in 2021, from 11.4 million in 2020 to 21.4 million in 2024. This enrollment growth has been concentrated among low-income individuals, spurred by the availability of low-cost (and in some cases, zero-premium) plans made available by the enhanced subsidies. Zero-premium plans are available to a larger share of ACA Marketplace enrollees in the 10 states that have not expanded Medicaid. Among states that use HealthCare.gov, enrollees in Florida and Texas received the most ($2.2 and $1.5 billion respectively) in enhanced IRA subsidies in 2024.