Will Americans Face a Healthcare Crisis as the New Year Begins?

As 2026 begins, many American families, including Adrienne Martin's, are facing a harsh reality without healthcare coverage due to soaring premiums resulting from the expiration of subsidies under the Affordable Care Act (ACA). Martin's family is grappling with an increase in their monthly healthcare premium from £467 to £1,781, forcing them to stockpile essential medications. This predicament is not unique; millions are at risk of losing affordable healthcare, highlighting a critical issue in the ongoing healthcare debate in the United States.

Last updated: 02 January 2026 (BST)

What’s happening now

The expiration of ACA subsidies at the end of 2025 has led to a dramatic increase in healthcare premiums for millions of Americans. Families like Adrienne Martin's face untenable choices as the cost of health insurance skyrockets, with reports indicating potential increases of up to 114% in monthly premiums. As Congress prepares to reconvene on 5 January 2026, a vote to extend these subsidies could offer a glimmer of hope for those affected. However, until then, many families must navigate the daunting prospect of being uninsured or paying exorbitant amounts for their coverage.

Key takeaways

Adrienne Martin's family faces a healthcare premium increase from £467 to £1,781 monthly.
Millions of Americans will lose ACA subsidies, leading to average premium hikes of 114%.
A vote on extending the subsidies is expected in early January 2026.

Timeline: how we got here

The lead-up to the current healthcare crisis can be traced through several key events:

2014: The Affordable Care Act (ACA) is enacted, introducing subsidies to help low- and middle-income Americans afford health insurance.
2020: The COVID-19 pandemic prompts an expansion of these subsidies, making healthcare more affordable for many.
2023: The longest government shutdown in U.S. history occurs, with efforts to extend subsidies at the forefront of negotiations.
December 2025: ACA subsidies expire, leading to immediate premium increases for millions.
January 2026: A vote on extending these subsidies is anticipated.

What’s new vs what’s known

New today/this week

As 2026 begins, families are grappling with the reality of increased healthcare costs, with immediate implications for those reliant on ACA subsidies. The upcoming vote in Congress provides a potential avenue for relief, but uncertainty looms as discussions remain gridlocked.

What was already established

The ACA has been in place since 2014, providing essential tax credits to millions of Americans. These subsidies were designed to make healthcare more accessible, but their expiration in December 2025 has triggered a return to unaffordable premium rates for many families.

Impact for the UK

Consumers and households

While this situation primarily affects American citizens, UK readers can reflect on their own healthcare system, the National Health Service (NHS), which offers universal coverage. The challenges faced by families in the U.S. serve as a reminder of the importance of accessible healthcare and the potential consequences of policy changes.

Businesses and jobs

In the U.S., businesses may face increased pressure as employees struggle with healthcare costs. Employers often bear part of the burden of providing health insurance, and rising premiums could lead to higher costs for businesses, impacting hiring and retention.

Policy and regulation

The outcome of the upcoming vote in Congress will be pivotal for the future of healthcare subsidies in the U.S. The debate around funding these subsidies and the associated costs will shape policy discussions for years to come.

Numbers that matter

24 million: The number of Americans purchasing health insurance through the ACA marketplace.
114%: The average potential increase in monthly healthcare costs without subsidies.
£1,781: The new monthly premium for Adrienne Martin's family, a significant financial burden.
$70,000: The monthly cost of IV medication for Martin's husband if uninsured.
$35 billion: Estimated annual cost of extending subsidies for three additional years.

Definitions and jargon buster

ACA (Affordable Care Act): A U.S. law enacted in 2010 to increase health insurance quality and affordability.
Subsidies: Financial assistance provided to lower the cost of healthcare premiums for eligible individuals and families.
Medicaid: A government program that provides health coverage for low-income individuals and families in the U.S.

How to think about the next steps

Near term (0–4 weeks)

Families should prepare for the possibility of increased healthcare costs and explore alternative options, including Medicaid or other state programs, if they become uninsured.

Medium term (1–6 months)

Monitor the outcome of the upcoming congressional vote on subsidies. If extended, families may regain access to affordable healthcare options. If not, the number of uninsured Americans is expected to increase.

Signals to watch

Congressional vote results on 5 January 2026 regarding ACA subsidies.
Trends in healthcare premium rates across the ACA marketplace.
Potential changes in state policies regarding Medicaid and other assistance programs.

Practical guidance

Do

Review your current health insurance options and costs as the new year begins.
Consider alternative coverage options if ACA subsidies are not extended.
Stay informed about legislative developments that could affect healthcare costs.

Don’t

Ignore the potential impact of rising healthcare costs on your finances.
Assume that healthcare coverage will remain affordable without government support.
Delay seeking assistance or exploring alternatives if you're facing unaffordable premiums.

Checklist

Check your health insurance coverage and premium rates for 2026.
Research Medicaid eligibility and application processes.
Stay updated on congressional discussions regarding ACA subsidies.
Consider your family's healthcare needs when evaluating plans.
Prepare a budget that accounts for potential increases in healthcare costs.

Risks, caveats, and uncertainties

There are significant uncertainties surrounding the outcome of the congressional vote on ACA subsidies. If the subsidies are not extended, millions of Americans may find themselves without affordable healthcare options. Additionally, the healthcare market may react unpredictably to changes in policy, potentially leading to further increases in premium rates and a rise in the number of uninsured individuals.

Bottom line

The expiration of ACA subsidies has left millions of Americans, including families like Adrienne Martin's, facing steep healthcare costs or the prospect of being uninsured. As Congress prepares for a crucial vote on 5 January 2026, the outcome could determine the future of affordable healthcare for many. The situation underscores the importance of ongoing discussions about healthcare access and affordability in the U.S.

FAQs

What are ACA subsidies?

ACA subsidies are financial assistance provided to help lower the cost of health insurance premiums for eligible individuals and families, making healthcare more affordable.

How much could healthcare costs increase without subsidies?

Without ACA subsidies, healthcare costs could rise by an average of 114%, significantly impacting many families' budgets.

What should families do if they lose their health insurance?

Families should explore alternative coverage options, such as Medicaid, and stay informed about legislative developments regarding healthcare subsidies.