Here is what is likely to happen – and what the insurance companies have been planning for:
- People who were getting some subsidies, but can, probably, afford to buy insurance without the subsidies will likely stay insured for 2026. They may well switch to a plan with a lower monthly premium (switch from a silver-tier to a bronze-tier plan, switch from a PPO to an HMO, switch to a plan with a narrower provider network, etc.)
- People who are going to struggle to pay the higher premium cost, but really need insurance (due to pre-existing conditions, expensive prescription drugs, etc.) are going to likely stay insured, but as you note, are going to have to “go without” on other things.
- People who are younger, and/or in generally good health, are going to just drop coverage entirely.
All of the above is what the insurance companies have assumed will happen; when they published their 2026 rates for ACA plans last summer, the average premium increase was around +25% nationally – they had to factor in that the young and healthy would be dropping out of their risk pools, and that it was going to cost more to insure those who remain.
Honestly, this past week represented a Hail Mary in Congress that the industry really didn’t expect would come through anyway. All of this is an oncoming train that the insurance industry has seen on the tracks since January.
And, as I noted above, Open Enrollment has been going on since November 1st; the “main OEP” deadline – to sign up or renew your coverage for January 1st – is this upcoming Monday (December 15th). The vast majority of people who are on these plans, and those getting subsidies, are already well aware of what’s happening, and just how much more their insurance is going to cost for January.