Health Costs Roundup: KFF's Latest on health care affordability and the ACA enhanced premium tax credits

How ACA Marketplace and employer-sponsored health insurance premiums, prescription drug costs, and more are impacting Americans.

View in browser Health Costs & Affordability Health care costs are a major concern for many Americans. If the Affordable Care Act (ACA) enhanced premium tax credits expire, over 20 million people will see their monthly premium payments double next year, on average. Additionally, premiums are increasing for people with employer-sponsored insurance, driven in part by rising inpatient and outpatient costs and the increased use of GLP-1 drugs to treat diabetes and obesity. KFF's latest research, polling, and journalism look at the issues of health care affordability and costs. View the latest below. ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire KFF estimates that, if Congress allows the enhanced premium tax credits to expire at the end of this year, ACA Marketplace enrollees on average would see their premium payments more than double next year, growing by 114%, from an average of $888 in 2025 to $1,904 in 2026.   Learn more → Annual Family Premiums for Employer Coverage Rise 6% in 2025, Nearing $27,000, with Workers Contributing $6,850 Toward Premiums   The 2025 Employer Health Benefits Survey provides a detailed look at trends in employer-sponsored health coverage, including premiums, worker contributions, cost-sharing provisions, offer rates, and more. This year's report also looks at how employers are approaching coverage of GLP-1 drugs for weight loss, including their concerns about utilization and cost.    Read the report → How ACA Marketplace Costs Compare to Employer-Sponsored Health Insurance   This analysis compares ACA Marketplace costs to employer-sponsored health insurance costs and finds that individual market premiums have become more similar to employer-sponsored premiums over time. In 2024, individual market insurance premiums averaged $540 per member per month, slightly below the average $587 per member per month premium for fully-insured employer coverage.   Explore the analysis → Support for Extending Enhanced ACA Tax Credits Remains High, But Dips Among Republicans   Public support remains high for extending the enhanced ACA tax credits set to expire at the end of the year, with three-quarters (74%) of the public in favor of extending them, though support among Republicans has dipped since September. Among those who want the tax credits extended, most say that either Congressional Republicans (38%) or President Trump (37%) would deserve most of the blame if they weren't extended. Fewer say Congressional Democrats (23%) would deserve most of the blame.   Learn more → CEO Drew Altman on Health Costs and Affordability   In recent "Beyond the Data" columns, Drew Altman discusses how spiking premiums, which may come if the enhanced ACA tax credits are not extended, will hit people in the context of their family budgets, alongside rising costs for food, housing and utilities, as well as the obstacles employers face trying to control their health care costs. The Semi-Sad Prospects for Controlling Employer Health Care Costs How an ACA Premium Spike Will Affect Family Budgets, and Voters The Two Health Care Cost Crises Policy Research ACA & EXPIRING ENHANCED TAX CREDITS Calculator: ACA Enhanced Premium Tax Credit The ACA's enhanced premium tax credits are set to expire at the end of 2025. This calculator estimates how much out-of-pocket premiums would increase for families if Congress does not extend the credits. The projected premium increases are estimated based on family income, zip code, size, ages, and 2026 ACA Marketplace premiums.   Video Explainers: If Congress Does Not Extend the Enhanced Premium Tax Credits Cynthia Cox, KFF's VP and Director of the Program on the ACA, breaks down what is at stake, who could be disproportionately affected if the enhanced tax credits expire, and what the loss of the tax credits could mean for different households.   ACA Insurers Are Raising Premiums by an Estimated 26%, but Most Enrollees Could See Sharper Increases in What They Pay KFF estimates that unsubsidized benchmark silver premiums for ACA plans will rise by about 26% in 2026 on average nationally, including state-based exchanges and states relying on Healthcare.gov. Most enrollees would face even sharper increases in what they pay if the ACA's enhanced premium tax credits expire.    Mapping the Uneven Burden of Rising Marketplace Premiums due to Subsidy Expiration The maps in this brief show how much average premium payments would increase for 2026 benchmark silver plans with the expiration of enhanced premium tax credits at three income levels above an income cap of 400% of federal poverty for a 40-year-old and 60-year-old individual, namely 401%, 501% and 601%.   What an Income Cap Could Mean for ACA Enrollees and the Federal Budgets Some members of Congress are considering an income cap on the ACA enhanced premium tax credits to lower federal costs. Depending on the income cutoff chosen, a cap may have little effect on the federal budget and a big effect on some households' budgets, particularly for older enrollees.   How Might Expiring Premium Tax Credits Impact People with HIV? People with HIV may be particularly vulnerable to expiring enhanced premium tax credits, given that they are more likely to have Marketplace plans and many also rely on the federally-funded Ryan White HIV/AIDS Program to help cover plan costs.    State Health Facts: Health Insurance Marketplaces Updated State Health Facts indicators on health insurance marketplaces enrollment and premiums. EMPLOYER HEALTH COVERAGE Perspectives from Employers on the Costs and Issues Associated with Covering GLP-1 Agonists for Weight Loss While more large employers are covering GLP-1 drugs for weight loss, KFF's conversations with employers highlight concerns about the cost of these medications. Many of these employers have considered scaling back coverage of GLP-1 agonists for weight loss, or in some cases, employers are adding or strengthening coverage requirements.   How Much do People with Employer Plans Spend Out-of-Pocket on Cost-Sharing? This chart collection examines trends in employee spending on deductibles, copayments, and coinsurance from 2012 to 2023 using a sample of health benefit claims for individuals under 65. PRESCRIPTION DRUG COSTS Upcoming Virtual Event: Developments in Prescription Drug Pricing under the Second Trump Administration RSVP to join three experts and Larry Levitt, executive vice president for health policy at KFF, for a 45-minute "Health Wonk Shop" discussion about the latest developments in prescription drug pricing and what they mean for drug manufacturers, patients and public and private health insurance programs.     Medicare Part D Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026 This brief looks at premium changes for Medicare Part D stand-alone prescription drug plans between 2025 and 2026. For plans that were offered nationwide in 2025 and will continue to be offered in 2026, Part D enrollees in many states will see lower monthly premiums in 2026.   For more, visit our kff.org Affordable Care Act or Health Costs topic pages, or go back to basics for an understanding of the issues with Health Policy 101. Polling Americans' Challenges with Health Care Costs   Recent polling data finds that many Americans struggle to afford many aspects of health care, including disproportionate shares of uninsured adults, Black and Hispanic adults and those with lower incomes.    Learn more →   Also, a November poll finds that many of the growing number of people who take GLP-1 drugs for weight loss or chronic disease find them difficult to afford. Health News Farmers, Barbers, GOP Lawmakers Grapple With Fate of ACA Tax Credits Small-business owners and their employees, who make up nearly half of the Obamacare marketplace, are worried about their health care and llivelihoods as insurance prices surge. Republicans, who have long opposed Obamacare, are at odds over how to respond to upset from one of their party's most loyal constituencies. (KFF Health News) Shutdown Has Highlighted Washington's Retreat From Big Ideas on Health Care As voters feel financial pressure from runaway health care costs and crave innovations that would provide relief, the standoff in Congress has been firmly rooted in the status quo — keeping an existing provision of the Affordable Care Act alive. (KFF Health News)    As Health Companies Get Bigger, So Do the Bills. It's Unclear if Trump's Team Will Intervene. As health systems, doctor groups, and insurers merge into ever-bigger giants, patient care gets more expensive. Yet the Trump administration has sent mixed signals about its willingness to intervene — and shown some disdain for Biden officials' more aggressive approach. (KFF Health News)    Health Care Costs Jump to the Fore as Candidates Jockey To Be California Governor During a California gubernatorial debate, candidates promised to protect people's access to health care and fight back against Trump administration cuts. With the contest a year away, polling shows voters want the next governor to minimize out-of-pocket health care costs, increase mental health care, and expand caregiving services. (KFF Health News)  Did someone forward this to you? Subscribe to KFF emails. This email was sent to awesomeblogger71.lificletter@blogger.com. Update your email preferences to choose the types of emails you receive. Or, permanently unsubscribe from all future emails. Need assistance? Email subscriptions@kff.org; do not reply to this email. 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