House Republicans passed a major tax and spending bill called the “One Big Beautiful Bill Act” on Thursday, which includes many financial changes but notably does not extend the enhanced premium tax credits under the Affordable Care Act (ACA). These credits, initially increased during the pandemic and extended until the end of 2025 by the Inflation Reduction Act, help make marketplace health insurance more affordable.

Without renewal, these subsidies will expire by the end of 2025, likely causing a rise in health insurance premiums for nearly everyone buying coverage through the ACA marketplace. Cynthia Cox from the Kaiser Family Foundation (KFF) said this will mean higher monthly costs and increased out-of-pocket expenses for many families. For instance, a family of four earning $85,000 could face an extra $313 per month in premiums and a $900 rise in maximum yearly out-of-pocket costs in 2026.

The enhanced tax credits helped ACA enrollment grow from 12 million in 2021 to over 24 million in 2025. If the subsidies expire, enrollment could drop by about one-third, leaving around 8 million people uninsured, according to KFF research.

Additionally, the GOP bill proposes increasing the share of income people pay toward premiums by 4.5% and raising the out-of-pocket maximum by the same percentage in 2026, further driving up costs.

The extension of premium tax credits remains politically contentious. While many Republicans oppose renewing the subsidies, at least two GOP senators—Lisa Murkowski and Thom Tillis—have expressed interest in continuing them. However, the current bill does not include this extension, though it might be addressed in future legislation.