Marketplace Pulse: Congressional Districts Where Affordable Care Act Enrollees Face the Highest Premium Increases in 2026, Ranked

The Marketplace Pulse series provides expert insights on timely policy topics related to the health insurance marketplaces. The series, authored by RWJF Senior Policy Adviser Katherine Hempstead, analyzes changes in the individual market; shifting carrier trends; nationwide insurance data; and more to help states, researchers, and policymakers better understand the pulse of the marketplace.

The establishment of the enhanced premium tax credits in 2021 greatly increased affordability in the Affordable Care Act (ACA) marketplace, where enrollment now exceeds 24 million. The tax credits are particularly helpful in high-cost areas, many of which are rural, since they constrain premium expenses to a fixed percentage of income. We have previously shown the importance of the ACA marketplace and Medicaid in farm states, where approximately 25% of the population is enrolled in one of these two programs. The enhanced premium tax credits currently provide support to nearly all ACA enrollees, but the role the tax credits play in increasing healthcare affordability varies geographically.

If Congress fails to extend the enhanced premium tax credits for ACA marketplace enrollees, residents in high-cost states could pay more than double the amount other people in America pay in 2026.

We highlight this point with two scenarios that illustrate the impact of a 50-year-old individual enrollee making approximately $60,000 per year (401% of the federal poverty level (FPL)) going from having a subsidy based on limiting the cost of a silver plan to 8.5% of their income to paying the full premium for the

(1) second-lowest cost silver plan in their zip code, and

(2) the lowest cost bronze plan in their zip code.

Premiums for enrollees losing access to enhanced premium tax credits would have at least doubled for the second-lowest cost silver plan in 28 congressional districts and doubled for the lowest cost bronze plan in 130 congressional districts in 2024.

For example, in 2024 an enrollee earning approximately $60,000 a year paid $428 per month for the second-lowest cost silver plan in their zip code, regardless of where they lived nationally. But without the enhanced premium tax credits, the cost of the benchmark silver plan in 2024 would vary significantly by region, costing only a little (0.7%) more in Minneapolis, Minn. ($430 per month) but in Marion, Ill. the same plan would cost 174% more ($1,171 per month). The difference reflects regional variation in the cost of healthcare, differences in population health, and also differences in the competitiveness of provider markets and transportation costs.

Table 1 shows the congressional districts where the second-lowest silver premiums would more than double without enhanced premium tax credits. As congressional reauthorization is required for tax credits to still be available above 400% FPL in 2026, we show the color for congressional representative’s party in each district and use a darker shade of blue and red to indicate where the premium would have been double or more (100% increase) in 2024 without enhanced premium tax credits.

Map 1: Percent Increase in Benchmark Silver Plan Premium for a 50-year-old at 401% FPL in 2024 Without Enhanced Premium Tax Credits

Prices drawn from the largest zip code in the congressional district

Again, a list of congressional districts where bronze plans with premiums of $200 or less would no longer be available includes districts won by Democrats and Republicans in all parts of the country.      

Table 2: Congressional Districts where the Lowest Cost Bronze Plan Cost $200 per Month or less for a 50-year-old enrollee at 401% FPL in 2024

Prices drawn from the largest zip code in the congressional district

View Table 2

Methodology: Premiums shown in the tables and figures come from the zip code with the largest population in each congressional district. As premiums can vary at the zip code level, the lowest cost bronze plan and the benchmark silver plan are not always uniform across the entire congressional district. Data on a plan’s availability at the zip code level comes from the Center on Consumer Information and Insurance Oversight’s (CCIIO) public use files. Estimated marketplace enrollment by congressional district comes from Charles Gaba’s analysis at ACAsignups.net. We intend to update this analysis for plan year 2025 premiums when data is fully available.

About the co-author:

Matthew Valeta is a data analyst with prior experience working for the California and Colorado marketplaces. At Covered California he led the development of the California Health Coverage Survey which continues to be conducted annually by NORC. Then at Connect for Health Colorado he led the relaunch of the marketplace's public website and implemented their 2020 open enrollment email and social media outreach campaigns. He currently works as a Health Plan Trainer for Denver Health Medical Plan. The data and findings in this article do not reflect the views of Denver Health Medical Plan. Matthew studied Political Science and Religion at Colorado College and received a Masters of Public Policy from the University of California, Berkeley in 2017.