At the end of 2025, despite a strong and active debate about the harm that would be caused, Congress failed to take action and allowed premium tax credit (PTC) enhancements to expire. Since then, health care premiums for Minnesota marketplace enrollees have risen by 30 percent, and 28 percent fewer Minnesotans are enrolled in marketplace insurance. Nationally, 3 million fewer people have marketplace coverage, and those who do have also seen rising costs.
Starting in 2021, enhanced premium tax credits (ePTCs) kept health insurance premium costs down for most people who buy their health insurance on the marketplace, known as MNsure in Minnesota. These Minnesotans include farmers, independent contractors, early retirees, and people who do not have affordable health insurance through their employer. In 2025, about 92,000 Minnesotans used premium tax credits to decrease their health insurance costs by roughly $360 a month.
Marketplace enrollment declines with the expiration of ePTCs
Enhanced premium tax credits contributed to the record high levels of health insurance coverage in Minnesota. But in 2026, after PTC enhancements were allowed to expire, roughly 41,000 fewer Minnesotans – a decrease of 28 percent – have coverage through marketplace insurance. As costs for health insurance premiums stack up throughout the year, even more marketplace enrollees are likely to drop coverage.
Some people who no longer have MNsure coverage could have found health insurance through their employer or another of the state’s pathways for affordable health coverage, but others are not able to afford increased premiums and instead became uninsured. A KFF poll found that about 1 in 10 marketplace enrollees nationwide from 2025 have become uninsured in 2026.
Health care costs are rising for MNsure enrollees
In 2026, about half of MNsure enrollees were eligible for premium tax credits. The average premium for all MNsure enrollees, including those not eligible for PTCs, increased by about $130 a month in 2026.
The expiration of PTC enhancements means fewer people qualify for this form of financial aid and now have to pay more for coverage than they would have before. During the COVID pandemic, premium tax credits were enhanced to further bring down the cost of health insurance premiums and eligibility was expanded to include households with somewhat higher incomes (above 400 percent of federal poverty guidelines, which is $132,000 for a family of four in 2026).
Because of Congress’s choice to let enhancements on PTCs expire, spikes in costs for insurance premiums have put pressure on household budgets and forced people to make tough choices about health coverage for themselves and their families.
Without affordable health insurance, people, hospitals, and the economy are all worse off
Affordable and accessible health care is a vital part of healthy and thriving communities, but the high costs of health insurance continue to be a barrier for many. A KFF survey found that in 2024 about 62 percent of uninsured adults cited the high cost of health insurance as the main reason.
People without health insurance often delay care for conditions that could have been caught and treated early, and they often wait to see a health care provider until these conditions are serious and possibly life-threatening. Hospitals see higher costs because of increases in uncompensated care, which happens when people without insurance cannot afford to pay the hospital for the health care they need.
In contrast, when they have health insurance, employees generally take fewer sick days because they get sick less often and are more likely to recover and go back to work sooner after an illness. Employers are then better able to maintain levels of service.
Lack of ePTCs add to other federal actions that put affordable health insurance out of reach for many
The loss of affordable health insurance through ePTCs was due to Congress’ choice not to act. Premiums for marketplace insurance are rising at the same time that Republican federal elected officials made the largest cuts in history to Medicaid through the passage of the massive tax and budget bill called H.R. 1. Cuts in eligibility, new restrictions and red tape, and funding reductions will make affordable health coverage harder to get, more difficult to maintain, and increase costs for people and states.
When people have health insurance, communities are healthier, hospitals are more financially stable, and the economy is better off. But federal actions continue to create barriers, take away coverage, and erode pathways to affordable health coverage for low- and middle-income people trying to afford their lives.