WASHINGTON — Lawmakers debating the future of dormant Obamacare health insurance subsidies have a simple example to consult: what Congress and the Biden administration did in 2021.
Back from their holiday break, members of Congress are mulling what to do with the subsidies, which expired last year. Their expiration triggered an average increase nationwide of 114% in premium payments for millions of Americans covered through the 2010 law. In New Jersey, which more robustly supported the health insurance market, premiums for 2026 plans rose far less, climbing an average 15.9%, though increases varied based on age and income.
Though patients across the country have picked 2026 insurance plans, Congress — where Republicans control both chambers — could still vote to extend the subsidies and the Trump administration could implement that extension, said Geraldine Doetzer, senior attorney for the National Health Law Program.
“The challenge is that people can’t simply wait to come to this decision,” Doetzer said in an interview with NJ Spotlight News. “They can’t float the cost of health coverage while people on the hill” debate this issue, Doetzer said. Millions of Americans are locked into their health plans for the year.
“Folks have had to sit down at their kitchen tables and make those decisions,” Doetzer said.
The House last week passed legislation that would extend the credit for three years. That and other bills face potential challenges, including the Senate, which could make amendments, and President Donald Trump, who has threatened to veto legislation to extend the subsidies.
Rep. Tom Kean Jr. (R-7th) was one of 17 House Republicans to vote with Democrats to vote for the bill to extend the subsidies for three years.
While it’s unclear whether Congress will revive the credits, or how legislation to do so would be structured, patients paying for health coverage in 2026 have already selected insurance options and are paying more, experts said.
“These marketplace enrollees are fronting the cost of this political uncertainty right now,” said Matthew McGough, a policy analyst at KFF, a nonpartisan health policy research, polling and news organization, who tracks the 2010 Affordable Care Act.
“There is no absolute drop-dead date for the expiration of these tax credits,” McGough said in an interview with NJ Spotlight News. Patients could be refunded through the federal tax process, McGough said.
As of last year, about 22.4 million people received the tax credit, including roughly 513,000 in New Jersey, according to KFF data.
In early 2021, months into the presidency of Joe Biden and in the depths of the COVID-19 pandemic, Congress passed legislation to expand who could qualify for aid. The next year, Congress extended the period when those subsidies — officially called “enhanced premium tax credits” — would run out, pushing the expiration date to Dec. 31, 2025.
In large part due to those expansion efforts, total enrollment under the 2010 law hit an all-time high in 2025, driven in large part by a boom of new enrollees in Republican-leaning states.
Enrollment jumped to 24.3 million last year from 11.4 million in 2020.
The top 15 states where health coverage under the ACA has grown most were all states Trump won in the 2024 presidential election, KFF found.
In New Jersey, enrollment reached about 513,000 last year, up from roughly 246,000 in 2020, a 108% increase.
After Congress established the tax credits in 2021, the Biden administration created a special enrollment period.
“For most people, they’re locked in,” David Kendall, senior fellow for health and fiscal policy at Third Way, a center-left think tank, said in an interview with NJ Spotlight News.
“If some extension were to pass Congress, it would include an extended open enrollment period,” said Kendall, making a prediction.
In the Senate, where Republicans hold a 53-47 majority, lawmakers are debating how to limit the tax credits by income.
Except under rare circumstances, legislation that passes the Senate must have support from the Senate majority leader, John Thune, a Republican from South Dakota. “Nothing will pass the Senate without his approval,” Kendall said. “And it’s all or nothing.”
Americans enrolled in the ACA fit a handful of descriptions. They may make too much money to receive Medicaid, the federal system for people with low incomes and disabilities. They may not be old enough for Medicare, insurance for seniors. And they likely don’t receive the option of coverage through their job.
Farmers and ranchers as well as small-business owners — groups often associated with Republican politics — are disproportionately reliant on the 2010 law for coverage, McGough said.
“While no Republicans voted for the passage of the ACA,” McGough said, “at this point their constituencies disproportionately benefit from the ACA.”
In some regions of Florida and Texas, more than 30% of people are covered by Obamacare, a target loathed by the American political right.
Because New Jersey has done more than other states to support its insurance market, through state-level subsidies and public education, it may weather the loss of tax credits better than other states should Congress do nothing, McGough said.
“New Jersey’s going to be pretty shielded from a lot of what’s happening,” he said. “It likely will not lose as many enrollees as other places in the country.”
