By Stacy M. Brown
Black Press USA Senior National Correspondent
With Donald Trump’s “Big Ugly” legislation now signed into law, health insurance premiums for millions of Americans are projected to spike in 2026, while critical subsidies for working families are being wiped out.
The law is a direct attack on the working class, the poor, and anyone not shielded by extreme wealth. According to multiple filings reviewed by KFF and the Peterson Center on Healthcare, premiums in the Affordable Care Act (ACA) marketplaces are poised to jump by a median of 15% nationwide in 2026. More than a quarter of insurance companies are seeking increases of 20% or more. KFF found that, at the center of this spike, is the law’s provision to end enhanced premium tax credits—financial assistance that helped more than 24 million people afford health coverage. Beginning in January 2026, these subsidies will disappear, and individual premium payments will increase by more than 75% on average for those who have been receiving them.
The impact will be especially devastating for low-income Americans. As healthier individuals exit the market due to rising costs, insurers warn that the remaining risk pool will become sicker and more expensive to cover. That’s expected to push gross premiums even higher, with the Congressional Budget Office projecting increases of at least 7.9% beyond the subsidy loss. “The enhanced premium subsidies are set to expire at the end of 2025,” Blue Cross Blue Shield of Vermont stated. “We expect that some healthy individuals with lower claims than average will forego health insurance… this will cause the premiums to increase by 6.6 percent”. Tariffs introduced under the new law are compounding the crisis. Trump’s tariffs on imported goods, including pharmaceuticals, are already pushing insurers to raise premiums beyond medical inflation. UnitedHealthcare, Optimum Choice, and other carriers cited the tariffs as justification for rate hikes ranging from 2.2% to 3.6% above their standard increases.
Prescription drugs made up 12% of private health insurance spending in 2023. With costs expected to climb under the new import restrictions, families will shoulder higher bills at the pharmacy and in their premiums. These changes hit vulnerable groups hardest. In 2023, nearly 30% of U.S. adults delayed or skipped medical, mental health, or dental care due to cost. Black and Hispanic adults, uninsured individuals, and people in poor health reported the highest rates of unmet care needs. About 16% of Black adults said they or a family member had trouble paying medical bills. Nearly half of all uninsured adults reported worrying about affording care if they got sick. That concern is now reality.
Insurers across the country are responding with steep rate hikes. Out of 105 ACA insurers reviewed, none proposed cutting premiums for 2026. Last year, at least some insurers lowered rates. The new law has erased that possibility. The United States already spends more per person on health care than any other wealthy nation—$13,432 per person in 2023, nearly twice the average of peer countries. And yet, U.S. residents remain more likely to go into debt for care, avoid treatment due to cost, and face financial ruin from an illness. “The expiration of these federal benefits increases premium costs for individuals and families and is expected to result in more people deciding to forego insurance coverage,” Blue Cross Blue Shield of Vermont warned. “This will shrink the population with coverage and worsen the risk pool, requiring higher premiums for the remaining members”.
