When Eileen Tyrrell logged into New York state’s health insurance marketplace in December, she says her monthly premium jumped from about $147 to $849.
“It was one of those moments where your stomach drops,” says Tyrrell, 26, who earned about $53,000 in 2025 as a bookstore manager in Brooklyn. She expects to earn around $72,000 in 2026, including her bookstore salary and income from content creation on TikTok.
Last year, federal premium tax credits covered about $510 of Tyrrell’s monthly premium, bringing the out-of-pocket cost of her Affordable Care Act bronze plan down to $147 a month. But between her higher income leading to a larger base premium and the expiration of enhanced pandemic-era subsidies, the same plan would cost her hundreds more per month.
The enhanced subsidies, first expanded in 2021 under the American Rescue Plan Act, removed the income cutoff for financial assistance and capped premiums at 8.5% of a household’s income, allowing more middle-income Americans to qualify for help.
However, Congress did not extend the provisions beyond 2025. While premium tax credits can still lower monthly costs for some Americans, eligibility is limited to households earning up to 400% of the federal poverty level — $62,600 for a single person in 2025 — a cutoff that was temporarily eliminated under the enhanced subsidies.
Enrollees just above the cutoff now have to pay the full cost of their coverage, according to KFF, a nonpartisan health policy research group. This includes Tyrrell, whose projected 2026 income puts her at about 460% of the federal poverty level, based on the KFF’s ACA marketplace calculator.
Nationally, the impact is already visible. Roughly 1 in 10 people who had ACA marketplace coverage last year are now uninsured, according to a March 2026 survey from KFF.
And for those keeping their existing plans, costs have risen sharply. A 2025 analysis by KFF estimated that premium payments for subsidized enrollees who stayed in the same plan would more than double on average after the enhanced tax credits expired.
“Losing ACA subsidies means breaking already fragile budgets for many people who are just starting in their careers and their financial lives,” says Cynthia Luna, a certified financial planner based in Texas.
“This just gives people more hard choices to make,” she says. “Food or medicine? Health-care coverage or savings?”Â
Just over 24 million people selected ACA marketplace plans for 2026, per KFF. The Congressional Budget Office estimates that about 2.2 million more people will be uninsured in 2026 than if the enhanced subsidies had remained in place, as higher premiums lead some to drop coverage or not enroll.
Cost relief at the state level
Efforts to restore the 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-funded subsidies to offset some of the increase, per KFF.
But in most states — including Tyrrell’s home of New York — middle-income enrollees face the full loss of enhanced federal aid. A single person in New York earning roughly $62,600 or more no longer qualifies for the subsidy, based on KFF’s ACA marketplace calculator. In comparison, a single, childless adult needs to earn $79,469 a year before taxes to cover basic necessities in Manhattan, according to the MIT Living Wage Calculator.
Those tradeoffs often show up quickly in household budgets. Some people are forced scale back discretionary spending or savings, while others cut essential expenses or drop coverage altogether when costs rise, says Luna.
“When people start making a little bit of money, they kind of get screwed. Because when you reach a certain threshold of income, you lose access to programs that might have been keeping you afloat,” says Tyrrell.
Rather than pay the increased premium on her bronze plan, Tyrrell switched to a catastrophic plan that costs $257 a month. But the financial risk hasn’t disappeared. Her catastrophic plan carries a $12,000 deductible, meaning she would have to pay the first $12,000 out of pocket before most benefits kick in.
“Health care is not really something that you can control,” Tyrrell says. “It’s not like I can set a goal of only spending X amount of money per month on health care.”
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