Everyone’s focused on the massive Medicaid cuts in Trump’s “Big Beautiful Bill” — and rightfully so. Millions stand to lose life-saving coverage. But there’s another crisis coming, and it’s being almost entirely overlooked:
The Affordable Care Act is going to collapse starting Jan 1st 2026
Unless Congress acts before the end of this year, the enhanced ACA subsidies — the ones that made marketplace coverage actually affordable — will expire on December 31, 2025. That means starting in 2026, millions of Americans will see their premiums double or triple overnight.
Right now, about 93% of marketplace enrollees receive premium subsidies. When those subsidies vanish, many people will simply stop paying for coverage. The healthy will exit first. The sick will be priced out. Risk pools will deteriorate. Insurers will leave the marketplaces.
We’ve seen this movie before — but this time it’s playing out at a much larger scale.
The Numbers Are Alarming
- Up to 10 million people could drop ACA coverage in 2026.
- Premiums could rise by 75–100% for middle-income families.
- States won’t be able to fill the gap — especially those that never expanded Medicaid to begin with.
This isn’t hypothetical. The CBO, Kaiser Family Foundation, and the Urban Institute have already run the numbers. Everyone agrees: millions will lose coverage if Congress doesn’t extend the enhanced subsidies.
The Political Distraction Works in Trump’s Favor
While Democrats and the media are rightly sounding alarms about Medicaid block grants, work requirements, and access to maternal care — the ACA cliff is sneaking up in the background. And Republicans are letting it happen.
They don’t need to repeal the ACA outright. They just have to let the subsidies quietly expire, and the whole system unravels on its own. No dramatic floor speeches. No repeal votes. Just silence — and collapse.
This Is the Death Spiral We Were Warned About
If millions drop coverage in a single year, insurers will hike premiums for the rest. Healthy people will bail. Insurers will pull out of rural markets. We’ll see bare counties again. Emergency rooms will take the hit. And everyone else’s premiums will rise — even those with employer plans.
This isn’t just a poor people’s problem. It’s a systemic problem.
Final Thought:
We’re not just looking at two separate policy failures. The expiration of ACA subsidies and the deep Medicaid cuts in Trump’s “Big Beautiful Bill for Billionaires “ are a one-two punch that could throw the entire U.S. healthcare system into a death spiral.
Hospitals will be overwhelmed. Insurers will flee. Premiums will soar. Millions will go without care. And even those with employer coverage will feel the shockwaves.
This isn’t just an attack on safety-net programs — it’s a coordinated collapse. And it’s happening in slow motion, right in front of us.
If we don’t stop it now, 2026 won’t just be a crisis year — it’ll be the year American healthcare started to fall apart.