Opinion: The Senate Let Obamacare's Subsidies Lapse. The Bill Is Coming Due.

Open enrollment for Affordable Care Act coverage begins Nov. 1, and for the second year running, the millions of Americans who buy their own insurance will find a marketplace in worse shape than the one they left. Congress has had nine months to prevent this. It has not, and the consequences are no longer projections in a policy brief — they are showing up in enrollment data, rate filings and insurer exit notices. The Senate should pass an extension of the enhanced premium tax credits that expired at the end of 2025, even a narrower and means-tested version, before the Dec. 15 enrollment deadline. Waiting longer does not preserve options. It locks in damage that has already started.

The Damage Is No Longer Theoretical

The enhanced premium tax credits, first created under the American Rescue Plan and extended through 2025, lowered what marketplace enrollees paid out of pocket by capping premiums as a share of income and eliminating the sharp subsidy cutoff for people earning just above the poverty-line threshold. They lapsed on Jan. 1. The effects arrived within weeks. According to an analysis from the health policy research organization KFF, effectuated marketplace enrollment fell from 21.8 million in February 2025 to 19.2 million in February 2026 — a 12 percent drop that KFF describes as the first enrollment decline in seven years. Premium payments net of the credits rose by an average of 58 percent for people who signed up for 2026 coverage.

Now the second-year effects are compounding the first. For 2027 coverage, insurers have proposed a median premium increase of 15 percent, based on filings from 276 insurers across all 50 states and the District of Columbia — the second consecutive year of double-digit increases, following an 18 percent proposed and 20 percent finalized increase in 2026. Insurers cite rising medical costs as the leading driver, but they also point explicitly to the expired credits and the resulting shift toward a sicker, smaller risk pool. As of today, KFF's insurer-participation tracker shows eleven carriers have announced they are leaving ACA marketplaces for 2027, up from seven just a few months ago. Cigna's exit is the largest, pulling out of the individual market entirely in the eleven states where it currently sells plans.

A Shutdown Fight That Was Never Actually Resolved

This was not an unforeseen accident. The expiring credits were the central dispute in last fall's 43-day federal government shutdown, the longest in history. Democrats refused to vote to reopen the government without a commitment to extend them; House Speaker Mike Johnson argued the credits were "filled with abuse" and should be negotiated separately from funding. The shutdown ended in mid-November on a promise of a Senate vote in December. That vote came on Dec. 11, when both a three-year Democratic extension and a Republican alternative built around health savings accounts failed to reach the 60-vote threshold, each falling 51-48. Four Republicans — Susan Collins, Josh Hawley, Lisa Murkowski and Dan Sullivan — crossed over to support the Democratic bill, but not enough others joined them.

The credits lapsed at year's end. In January, House Democrats forced a floor vote using a discharge petition, and the chamber passed a three-year extension 230-196, with seventeen Republicans joining every Democrat present.

"Now, the Senate and the President must follow suit," Rep. Joe Courtney, D-Conn., said after the vote.

Nine months later, nothing in the public record indicates the Senate has taken that bill up. Bipartisan talks on a narrower compromise — the HOPE Act, which would have extended the credits for two years with a $200,000 income cap for a family of four and added fraud-verification requirements — reportedly collapsed not over the subsidy design itself but after Republicans pushed to add abortion-coverage restrictions to marketplace plans, according to Sen. Angus King, I-Maine, who helped broker the shutdown-ending deal.

Who Is Exposed

The people absorbing this are not an abstraction. They include:

• Early retirees, self-employed workers and small-business owners who buy coverage on the individual market and have no employer plan to fall back on.
• Households earning just above 400 percent of the federal poverty line — $63,840 for a single person in 2027 — who now face the return of a hard subsidy cliff, losing all assistance regardless of how much their premium costs.
• Residents of states where insurer exits leave only a handful of competitors; Indiana, for instance, will have just three marketplace insurers left after CareSource and Cigna withdraw, absent new entrants.
• Lower-income enrollees who remain subsidized but are shifting into skimpier plans with higher deductibles — which KFF has separately documented rising to record levels — to keep premiums affordable.

The Fraud Argument Does Not Require Full Repeal

Republican concerns about the enhanced credits are not baseless. Looser income-verification rules adopted during the pandemic did make it easier for brokers to enroll people in subsidized plans without their knowledge or consent, and federal auditors have flagged improper payments tied to income misreporting. But that is an argument for tightening verification, not for lapsing the entire program and letting the fraud debate substitute for a policy decision. The HOPE Act proposal specifically paired an extension with anti-fraud provisions and an income cap meant to blunt the cost and abuse concerns Republicans raised. That it still failed — reportedly over an unrelated abortion-policy demand — suggests the sticking point was not actually fraud.

What Should Happen Now

The realistic window for action is narrow. The federal marketplace's open enrollment window runs from Nov. 1 through Jan. 15, with Dec. 15 as the deadline to enroll for coverage starting Jan. 1. A Senate vote before that date could still blunt the worst of the 2027 increases for people who have not yet finalized a plan; after it passes, insurers and enrollees will have made decisions based on the current, unsubsidized prices, and a later fix would do less good. Given that two competing proposals already died in the Senate in December and Senate Republican leadership has remained publicly noncommittal on reviving the issue, the more likely outcome is that nothing passes before the deadline, and the first full post-subsidy enrollment cycle proceeds as scheduled.

That outcome is a choice, not an inevitability. The House has already shown, with seventeen Republicans crossing party lines in January, that a bipartisan majority for some extension exists when the vote is finally held. The Senate owes the roughly 20 million people who rely on the individual marketplace the same vote, paired with the fraud and income-cap safeguards that Republicans have asked for, before another enrollment season closes on terms that were avoidable.