Parsing the Rhetoric on ACA Subsidies – FactCheck.org

In a social media post, Republican Sen. Ron Johnson criticized Sen. Bernie Sanders, an independent, for wrongly saying that Affordable Care Act premiums would at least double for “over 20 million Americans” if enhanced subsidies expire. They would more than double on average, not for all of those 20 million people. Johnson glossed over the higher out-of-pocket premiums, saying that the “subsidies will likely increase, not decrease.”

The Wisconsin senator essentially invited us to weigh in on this, writing, “Calling all fact checkers!” in his Nov. 11 post on X. We’ll explain what Sanders got wrong and what Johnson left out about the enhanced tax credits, which are due to expire at the end of the year.

Democrats wanted an extension of the subsidies to be part of legislation to continue funding the federal government, but Republicans rejected that. As part of a Senate deal that ended the government shutdown this month, the Senate will hold a vote in December on those boosted subsidies.

As we’ve explained before, the ACA provided subsidies for people buying their own insurance on the ACA marketplaces if they earn between 100% and 400% of the federal poverty level (the starting point is 138% in states that adopted the Medicaid expansion). The poverty level for this year is $15,650 for an individual or $32,150 for a family of four. In 2021, the subsidies were expanded as part of pandemic relief legislation and later extended through the end of 2025.

The enhancement increased financial help by changing the percentage of income people have to pay toward premiums before the subsidies kick in, and it eliminated the 400% income cap. Those earning above that can get subsidies if premiums cost more than 8.5% of their income. The vast majority, 92%, of the 24.3 million ACA enrollees receive subsidies, according to the Centers for Medicare & Medicaid Services.

Out-of-Pocket Premiums Double on Average

Sanders has repeatedly said that premiums would “double” for “more than 20 million Americans” if the enhanced ACA subsidies expire. Johnson highlighted Sanders saying on the Senate floor on Nov. 10, “Are you prepared, I say to my Republican friends, to sit back and allow over 20 million Americans to see a doubling of their health care premiums?” Johnson said that Sanders “is simply wrong.”

The Vermont senator is wrong to say that all 20+ million would see a doubling. The out-of-pocket premiums for those getting ACA subsidies would more than double on average, according to an analysis by the nonpartisan health policy organization KFF. The average increase is 114%, or $1,016, in 2026.

“On average, 22 million people will see their premium payments double. Some will see them more than double. Some will see them less than double, because that is the nature of an average,” Cynthia Cox, a KFF vice president and director of the Program on the ACA, told us in a phone interview. “The vast majority of people, whether they get a tax credit or not, are going to see their costs go up next year to keep the same plan.”

Sanders’ office referred us to the KFF analysis and acknowledged that he meant that the doubling was an average.

As we’ve explained before, the potential impact of losing the enhanced subsidies can vary greatly, depending on an enrollee’s age, income, family size and location.

In his Nov. 10 remarks, Sanders added that some would see “a tripling or a quadrupling,” and that’s correct. KFF’s analysis shows some out-of-pocket premium costs could triple, and those who are in their 60s and earning just over the 400% threshold could see a quadrupling. Those earning above 400% of poverty would lose any subsidies they’re receiving now if the enhancement expires.

Enrollees’ Required Payments Increase

In his X post, Johnson went on to say: “The TRUTH is that 22 of the 24 million Americans on Obamacare exchanges will continue receiving Obamacare subsidies as originally designed. The dollar amount of those subsidies will likely increase, not decrease, since they are tied to Obamacare’s skyrocketing premiums.” (Emphasis is his.)

The dollar amount of subsidies could increase, as Johnson said, since premiums are going up and enrollees’ required contribution is capped at a percentage of income. However, Johnson’s statement could leave a misleading impression, since he leaves out that the amount people have to pay out-of-pocket still would go up if the enhanced subsidies expire, because they’ll be required to pay a higher percentage of their income.

The enhanced subsidies reduced the percentage of income people have to pay toward premiums. These required contributions are on a sliding scale. Those at 200% to 250% of poverty used to pay around 6% to 8% of income; the enhanced subsidies lowered that to 4% to 6%. Those at 300% to 400% of poverty used to pay 9.5% of their income; the enhanced subsidies lowered that to 6% to 8.5%. (See Figure 4 in this report from the Bipartisan Policy Center.)

With the expiration of the enhanced subsidies, “it’s possible to both get a larger tax credit and still pay more out of your own pocket, much more out of your own pocket,” Cox told us. “Pretty much everyone who gets their own insurance, who buys their own insurance, will see an increase in what they have to pay.”

When we asked Johnson’s office about his statement, Press Secretary Grace Carnathan told us in an email: “The senator is pointing out how the original ACA subsidy formula functions. The federal tax credit is tied to the benchmark premium, so when premiums rise, the dollar value of the subsidy also rises. According to CMS, in 2026 subsidies will cover about 91 percent of the lowest-cost plan’s premium for eligible enrollees, meaning enrollees pay only a small share of the total cost.” (Here’s the CMS report.)

“Gross premiums are the most relevant metric to use in evaluating the failure of Obamacare to restrain insurance costs,” Carnathan said.

Under the enhancement, many of those earning between 100% and 150% of the poverty level got insurance for $0, but they’ll pay up to about 4% of their income if the boosted subsidies expire. The KFF analysis shows that an individual earning $22,000 would pay $794 in 2026 and a family of four earning $45,000 would pay $1,607, both up from $0 with the enhanced subsidies.

Johnson noted that premiums can’t double for those paying zero dollars. “For people who paid nothing under the enhanced subsidy, asking them to pay a small amount is an infinite increase — but you can’t double zero,” he said. “Fewer than 2 million Americans with incomes above 400% of the Federal Poverty Line will lose the temporary COVID relief subsidies that Democrats set to expire. I’m happy to work with Democrats to ensure that those people have affordable health care insurance options, but first they need to stop lying and admit that Obamacare is a miserable failure.”

Nearly 6.7 million enrollees in 2025 selected plans that cost them nothing in premiums. That’s 39% of the 17.1 million who got a plan through the federal HealthCare.gov, according to CMS. We don’t have a breakdown for the 7.2 million on state-based exchanges, though zero-dollar plans are less common there, Cox said.

Johnson is correct to say that fewer than 2 million people with incomes above 400% of poverty (it’s 1.6 million) will lose any ACA subsidies they receive, since they’re only eligible for financial assistance under the enhancement. (There’s another 1 million enrollees who haven’t provided income information, “but it is likely they have higher incomes and have not applied for tax credits,” KFF says.)

The total premium charged by insurers for ACA plans for 2026 is going up by 26% on average, according to KFF. That’s for the benchmark silver-level plan used to determine tax subsidies. In an Oct. 28 post, Cox explained the several reasons for the increase — “increasing hospital costs, the rising popularity of expensive GLP-1 drugs like Ozempic, and the threat of tariffs,” factors also affecting employer-based premiums. The expiration of the enhanced subsidies is another factor. “In their 2026 filings to state regulators describing their requested premium increases, ACA Marketplace insurers said they would charge about 4 percentage points more, on average, than they otherwise would have because they expected healthier people to drop Marketplace coverage if enhanced premiums tax credit expire.”

The nonpartisan Congressional Budget Office estimated that 4.2 million more people will lack health insurance in 2034 due to the expiration of the enhanced subsidies. The Urban Institute estimated that 4.8 million more would lack insurance next year.

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