With enhanced Affordable Care Act (ACA) premium tax credits set to expire at the end of the year, time is running out for Congress to decide whether to extend the subsidies to help Americans afford health care coverage. Meanwhile, a new poll shows 1 in 4 consumers would likely go without insurance if the subsidies expire and a government report finds the ACA marketplaces are vulnerable to fraud.
The subsidies help make premiums more affordable for eligible Americans who purchase insurance in the ACA marketplace.
Currently 22 million marketplace enrollees have received the subsidies and if they are allowed to expire, their premiums are expected to rise an average of 114 percent from $888 to $1,904, according to KFF.
The Senate is expected to vote on an extension proposal for the enhanced ACA tax credits on December 11. Politico reports that Senate Democrats plan to propose a three year extension for the subsidies, but it’s unclear whether it could gather the 60 votes needed as some Senate Republicans have indicated they would support a two-year extension with income caps. Others prefer an alternative to convert subsidies into Health Savings Accounts.
During a Senate Health, Education, Labor and Pensions (HELP) Committee hearing on Wednesday to discuss rising health care costs, Chairman Bill Cassidy, R-La., said he hopes Democrats and Republicans can agree on a bill that will make health care more affordable for Americans in 2026 and in the future.
“It shouldn’t be a Republican solution, it shouldn’t be a Democratic solution, it should be an American solution,” he said, adding that lawmakers shouldn’t spend time on extreme ideas that won’t pass the Senate floor. “We’ve got to minimize the amount of new law if we want to help people in 2026. I’m just speaking practically. If you want an American solution, this is the reality.”
But preliminary results from a new report by the Government Accountability Office (GOA) may give some Republicans more reasons to argue against an extension. The watchdog report finds that fraud risks persist with the premium tax credit. The GAO last assessed the program’s fraud risks in 2018 and said in the updated report that inspectors were able to obtain subsidized insurance for fake enrollees and also had issues with potential identify fraud using Social Security numbers.
The GAO created four fake enrollees to obtain health insurance for plan year 2024. All were approved. In total, the Centers for Medicare & Medicaid Services (CMS) paid about $2,350 per month for the enhanced subsidies in November and December for these fictitious enrollees. Although the marketplace asked for information to support Social Security numbers (SSN), citizenship, and reported income for some enrollees, GAO did not provide documentation yet received coverage.
Among the 20 fake applicants the GAO created for plan year 2025, 18 were actively covered as of September 2025, costing the government over $10,000 per month.
However, GAO emphasized that its fraud testing is illustrative and cannot be generalized to all marketplace enrollees.
Meanwhile, a new opinion poll conducted by KFF shows that Americans are reconsidering coverage on the ACA marketplace. The poll of 1,350 U.S. adults who purchase coverage on the ACA marketplace found that if the amount they pay for premiums doubled, 1 in 3 enrollees would be “very likely” to look for a lower-premium, marketplace plan (with higher deductibles and co-pays) and 1 in 4 would “very likely” go without insurance next year.
Nearly 6 in 10 enrollees (say they would not be able to afford an increase of just $300 per year in the amount they pay for insurance without significantly disrupting their household finances. An additional 1 in 5 say they would not be able to afford a $1,000 per year increase in the amount they pay for health insurance.
“The poll shows the range of problems marketplace enrollees will face if the enhanced tax credits are not extended in some form, and those problems will be the poster child of the struggles Americans are having with health care costs in the midterms if Republicans and Democrats cannot resolve their differences,” KFF President and CEO Drew Altman said in a news announcement.