US: Millions Lost Health Insurance When Subsidies Expired

(Washington, DC) – The United States Congress’ failure to extend public subsidies for private health insurance has caused millions to lose healthcare coverage, increasing financial hardship and deepening inequality, Human Rights Watch and Oxfam America said today. Six months after the subsidies expired on January 1, 2026, early data indicate that millions of households lost health insurance and face sharp increases in healthcare costs.

When the One Big Beautiful Bill Act (OBBBA) became law in July 2025, it extended and deepened tax cuts that overwhelmingly benefit the ultra-wealthy while allowing important subsidies for health insurance plans purchased through government-operated marketplaces to lapse. More than one million fewer people enrolled in marketplace plans in 2026 than in 2025, and reporting indicates many who did enroll subsequently dropped coverage because of failure to pay their premiums. An actuarial firm estimatesthe number of people covered through marketplace plans could ultimately fall to as low as 16.5 million this year, a decline of nearly 6 million from 2025.

“Congress’ choice to let these subsidies end has led millions to become uninsured and is forcing many to pay far more for care that they have a right to,” said Matt McConnell, economic justice and rights researcher at Human Rights Watch. “Lawmakers shouldn’t force ordinary people to sacrifice their health to pay for tax breaks for the wealthy.”

The 2010 Affordable Care Act expanded access to health care by regulating private insurance and creating public marketplaces where people without public or employer healthcare coverage could buy private plans. It also established subsidies to lower premiums for private health insurance purchased through one of these marketplaces, though it excluded people earning above 400 percent of the federal poverty level. This “subsidy cliff” disproportionately affected middle-income earners, many of whom did not earn enough to afford quality health insurance, and older adults not eligible for Medicare, who also face higher premiums because of their age.

In 2021, Congress temporarily addressed this by expanding eligibility and capping premiums at 8.5 percent of household income. These increased subsidies, or “enhanced premium tax credits,” later extended through 2025 by the Inflation Reduction Act, significantly reduced costs and helped more than double marketplace enrollment from 2020 to 2025, contributing to a decline in the uninsured rate over this period. By 2025, approximately 24.3 million people obtained health insurance through one of these marketplaces, according to KFF, a nonprofit health policy research organization.

With the OBBBA in 2025, Congress chose not to extend these enhanced subsidies in favor of major, inequality-fueling tax cuts in which the richest 0.1 percent of households will pay roughly $50 billion less in taxes annually over the next eight years. The enhanced subsidies had cost about $35 billion per year.

In late 2025, Congress reached an impasse resulting in a federal government shutdown, as Democratic Party lawmakers sought to secure an extension of these subsidies. The House of Representatives passed an extension in January 2026, but it stalled in the Senate.

“Congress is cutting health care for millions of people in order to enrich the very wealthiest and huge corporations. It’s a case of grossly misplaced priorities, plain and simple,” said Jackson Gandour, senior policy advisor for economic justice at Oxfam America. “These callous decisions fuel extreme inequality and deny human rights to millions, making our society less healthy and more unstable.”

Monthly marketplace insurance premiums rose about 58 percent this year, from an average of about $113 to $178, with the steepest increases for older people and those earning above 400 percent of the federal poverty level ($63,840 on average for an individual in 2026). However, some states partially offset these increases, with New Mexico offsetting them completely.

In early 2026, 9 percent of adults polled by KFF who had marketplace coverage in late 2025 had become uninsured, with 80 percent citing increased cost as the reason. Among those who had retained coverage through a marketplace plan, 17 percent were not confident they could afford their premiums for the entire year, and more than half had cut or planned to cut spending on household expenses such as food and clothing to afford health care.

“At my age, everything right now is about surviving the next seven years until I can start drawing down on Social Security and get on Medicare,” said a former USAID foreign service officer interviewed by Human Rights Watch.

After losing her contract with the agency last year, she struggled to find work and earns about $700 per month as a substitute teacher. She is ineligible for Medicaid because she lives in a state that did not expand coverage to adults without dependents and pays $1,100 per month for a marketplace plan. She sold her car and moved in with family to reduce expenses and is considering moving to a state where she is eligible for Medicaid.

Official data on the number of people without health insurance are not yet available for this year, but early indicators suggest millions have lost health insurance. Marketplace enrollment declined in 41 states, with decreases as large as 22 percent in North Carolina and 20 percent in Ohio. Although those earning just above the subsidy cliff comprised only 3 percent of enrollees last year, they accounted for 27 percent of this decline nationwide.

Many more people who initially enrolled in a marketplace plan for 2026 may have already become uninsured or will become uninsured in the coming months. According to the actuarial firm Wakely Consulting Group, about 14 percent of those who enrolled in marketplace plans this year did not pay their first monthly premium. The news site NOTUS reported in May on internal Centers for Medicare and Medicaid Services documents that showed a roughly 21 percent decline in enrollment because of unpaid premiums during the first month of this year in the 30 states using the federal marketplace.

Millions more switched to poorer-quality plans with cheaper premiums and higher deductibles, driving the average deductible for marketplace plans up from $2,759 in 2025 to $3,786 in 2026. A 2025 peer-reviewed study published in an American Medical Association’s medical journal found that adults enrolled in high-deductible plans were less likely to receive recommended medical care than those in non-high-deductible plans.

The loss of these subsidies may have also contributed to a sharp increase in the cost of private health insurance purchased outside of these marketplaces. In March, the Federal Reserve Bank of New York found that employee health insurance costs increased by an average of 14.2 percent among northeastern manufacturers surveyed and 12.9 percent among service firms.

Under international law, everyone has the human right to health, which requires access to health care regardless of one’s ability to pay. By failing to extend these subsidies in favor of tax cuts, US authorities have dramatically reduced access to health care, undermining this human right, worsening inequalities, and impeding the enjoyment of other human rights like housing, food, and education.

“US lawmakers need to learn from the many countries with far fewer resources that do much better at realizing the right to health,” McConnell said. “In the meantime, they shouldn’t be forcing families to choose between paying for health care and rent.”