Congress Urged to Act as Millions Lose Health Coverage After Subsidy Expiration
TL/DR –
The U.S. Congress’s failure to extend public subsidies for private health insurance has caused millions of Americans to lose their healthcare coverage, according to Human Rights Watch and Oxfam America. This was due to the One Big Beautiful Bill Act (OBBBA) passed in July 2025, which extended tax cuts for the ultra-wealthy but allowed important health insurance subsidies to lapse. The removal of subsidies has led to a sharp increase in healthcare costs and has resulted in nearly 6 million fewer people being covered through marketplace plans this year compared to 2025.
Congress Must Act to Ensure Equal Access to Health Care
Congress’ failure to extend public subsidies for private health insurance has resulted in millions losing healthcare coverage, increasing financial hardship and deepening inequality, according to Human Rights Watch and Oxfam America. The expiration of subsidies on January 1, 2026 led to sharp increases in healthcare costs for many households.
The One Big Beautiful Bill Act (OBBBA) introduced in July 2025 allowed important health insurance subsidies to lapse, benefiting the ultra-wealthy through tax cuts. Subsequently, enrollment in marketplace plans dropped, and many who enrolled stopped coverage due to inability to pay premiums.
“The decision to end these subsidies resulted in millions becoming uninsured and forced many to pay more for care that they have a right to,” said Matt McConnell, economic justice and rights researcher at Human Rights Watch. “Congress shouldn’t make ordinary people sacrifice their health for tax breaks for the wealthy.”
The 2010 Affordable Care Act expanded access to health care and created public marketplaces for purchasing private plans. However, it also established a “subsidy cliff” that disproportionately affected middle-income earners and older adults who face higher premiums due to their age.
In 2021, Congress temporarily addressed this by expanding eligibility and capping premiums. These increased subsidies, or “enhanced premium tax credits,” helped to more than double marketplace enrollment from 2020 to 2025, contributing to a decline in the uninsured rate.
However, with the OBBBA in 2025, Congress did not extend these enhanced subsidies, favoring major, inequality-fueling tax cuts instead. The enhanced subsidies had cost about $35 billion per year.
“Congress is cutting health care for millions to enrich the very wealthiest. It’s a case of grossly misplaced priorities,” said Jackson Gandour, senior policy advisor for economic justice at Oxfam America.
In 2026, monthly marketplace insurance premiums rose about 58 percent. The steepest increases were for older people and those earning above the federal poverty level. However, some states, like New Mexico, offset these increases.
Approximately 9 percent of adults surveyed who had marketplace coverage in late 2025 had become uninsured by early 2026, and 80 percent of them cited increased cost as the reason.
Official data on the number of people without health insurance are not yet available for this year, but early indicators suggest millions have lost health insurance. Marketplace enrollment declined in 41 states, with decreases as large as 22 percent in North Carolina and 20 percent in Ohio.
Many more people who initially enrolled in a marketplace plan for 2026 may have already become uninsured or will become uninsured in the coming months. The news site NOTUS reported in May on a roughly 21 percent decline in enrollment due to unpaid premiums.
Millions more switched to poorer-quality plans with cheaper premiums and higher deductibles, driving the average deductible for marketplace plans up from $2,759 in 2025 to $3,786 in 2026.
“US lawmakers need to learn from the many countries that do much better at realizing the right to health,” McConnell said. “In the meantime, they shouldn’t be forcing families to choose between paying for health care and rent.”
For more Human Rights Watch reporting on economic justice and rights, please visit: https://www.hrw.org/topic/economic-justice-and-rights
For more of Oxfam America’s work on US inequality, please visit: https://www.oxfamamerica.org/explore/issues/economic-justice/inequality-in-the-us/
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