Analyzing Claims About Affordable Care Act Subsidies

In a heated exchange over health care costs, Republican Sen. Ron Johnson and Independent Sen. Bernie Sanders have clashed over the potential impact of expiring Affordable Care Act subsidies, highlighting a significant policy dispute as enhanced benefits approach their end date.

Sanders claimed that “over 20 million Americans” would see their health care premiums double if enhanced ACA subsidies expire at year’s end. Johnson quickly challenged this assertion on social media, calling for fact-checkers to evaluate the claim while arguing Sanders was “simply wrong.”

Analysis from the nonpartisan health policy organization KFF reveals a more nuanced reality. While Sanders overstated by suggesting all subsidized enrollees would face doubled costs, the data shows premiums would indeed more than double on average—increasing by 114%, or about $1,016 annually. Cynthia Cox, a KFF vice president, clarified: “Some will see them more than double. Some will see them less than double, because that is the nature of an average.”

Sanders’ office acknowledged that he was referring to an average increase rather than a uniform doubling for all recipients. The senator had also accurately noted in his floor speech that some Americans could see “a tripling or a quadrupling” of costs, which KFF data confirms is possible, particularly for older adults with incomes just above 400% of the federal poverty level.

The enhanced subsidies, initially implemented as pandemic relief in 2021 and later extended through 2025, increased financial assistance by lowering the percentage of income people must pay toward premiums and eliminating the 400% income cap. Currently, 92% of the 24.3 million ACA enrollees receive these subsidies.

Johnson’s response that “subsidies will likely increase, not decrease” since they are tied to premium costs omits crucial context. While the dollar amount of government subsidies might increase as overall premiums rise, Americans would still pay substantially more out of pocket because they would be required to contribute a higher percentage of their income toward premiums if enhancements expire.

Under the enhanced structure, many low-income enrollees currently pay nothing for coverage. KFF projects that an individual earning $22,000 would go from paying $0 to $794 in 2026 without the enhanced subsidies. Similarly, a family of four earning $45,000 would see costs rise from $0 to $1,607.

Approximately 6.7 million enrollees—39% of those using the federal HealthCare.gov platform—currently have zero-premium plans. Additionally, about 1.6 million people with incomes above 400% of the poverty level would lose all subsidies if the enhancements expire.

The debate occurs against a backdrop of rising insurance costs. Total premiums for ACA plans are projected to increase by 26% on average for 2026, driven by hospital cost increases, expensive GLP-1 medications like Ozempic, potential tariffs, and insurer concerns about healthier individuals dropping coverage if enhanced subsidies end.

Congressional Budget Office estimates suggest 4.2 million more Americans could lack health insurance by 2034 if the enhanced subsidies expire, while the Urban Institute projects 4.8 million more uninsured as early as next year.

The issue has become a political flashpoint. Democrats attempted to include an extension of these subsidies in recent government funding legislation, but Republicans rejected the proposal. As part of the Senate agreement to end this month’s government shutdown, a vote on extending the enhanced subsidies is scheduled for December.