Changes adopted in the FY 2026 budget reconciliation bill (“the One Big Beautiful Bill” Act) could result in a significant increase in the ranks of the uninsured across the country.

According to an Urban Institute analysis supported by the Commonwealth Fund, if current expanded health insurance premium tax credits end with the beginning of the new federal fiscal year on October 1,

  • 4.8 million more people would become uninsured, a 21 percent increase.
  • 3 million fewer people across the U.S. would get subsidized marketplace coverage.
  • Premiums would soar.  For people earning less than 250 percent of poverty (about $39,000 for an individual and $80,000 for a family of four), average annual premiums would jump from $169 to $919.

A new analysis from the Congressional Budget Office of the estimated effects on federal deficits and health insurance coverage that would occur if certain changes to current law take effect on September 30, 2025 reaches similar conclusions.  Approaching the issue in a slightly different manner, the CBO concludes that:

  • Permanently expanding the premium tax credit structure as provided in the American Rescue Plan Act of 2021 and later extended through calendar year 2025 in the 2022 reconciliation act, would increase the deficit by $350 billion from 2026 to 2035 and the number of people with health insurance by 3.8 million in 2035.
  • Nullifying a final rule published in June 2025 by HHS related to the health insurance marketplaces established by the Affordable Care Act would increase the federal deficit by $40 billion from 2026 to 2035 and the number of people with health insurance by 300,000 in 2035.
  • Repealing sections of the 2025 reconciliation act related to the health insurance marketplaces would increase the deficit by $272 billion from 2026 to 2035 and the number of people with health insurance by 2.9 million in 2035.

Learn more about how the Urban Institute reached its conclusions from its report “4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire” and about the CBO’s findings from its report “The Estimated Effects of Enacting Selected Health Coverage Policies on the Federal Budget and on the Number of People With Health Insurance.”