Health insurance customers across Arkansas, North Dakota, and Pennsylvania are bracing for sweeping premium hikes in 2026, with many facing the prospect of losing crucial federal subsidies that have kept coverage affordable for years. State insurance regulators, consumer advocates, and policyholders themselves are warning of a looming affordability crisis, as the expiration of enhanced federal premium tax credits—originally expanded during the COVID-19 pandemic—threatens to push prices beyond the reach of thousands.
In Arkansas, the state Insurance Department (AID) approved an average rate increase of 22.2% for individual health plans for the 2026 plan year. That figure, announced by Governor Sarah Huckabee Sanders on September 19, 2025, is down from the 36.1% hike insurers had initially proposed in August. Still, it represents the largest one-year increase on record for the state. According to the Arkansas Center for Health Improvement, the approved rate hike covers more than 350,000 enrollees on individual on- and off-market plans. Small group off-market plans, covering nearly 60,000 Arkansans, will see a 7.9% average increase—unchanged from earlier filings.
Insurers in Arkansas have attributed the dramatic increases to a confluence of policy changes at both the state and federal levels. Chief among these is the expected expiration of enhanced premium tax credits for marketplace plans, combined with the pending implementation of Medicaid work requirements. Other factors cited in filings include new state laws regulating pharmacy benefit managers, limiting prior authorizations, and mandating certain benefits. As the Arkansas Insurance Department reviews rate proposals annually, it must ensure they are neither excessive nor discriminatory. Despite efforts to temper the increases, the 22.2% jump dwarfs the 6.2% increase approved for 2025 and marks a stark departure from Arkansas’s historical trend of lower-than-average premiums compared to surrounding states.
Pennsylvania is experiencing a similarly jarring adjustment. On October 14, 2025, state officials announced that premiums for individual and small group plans on the Affordable Care Act (ACA) marketplace will climb by nearly 22% on average for 2026. The state’s insurance commissioner, Michael Humphreys, noted that some insurers are raising premiums by as much as 38% in the individual market and 22% in the small group market, even after the department blocked $50.1 million in proposed excessive increases. The 496,000 Pennsylvanians currently enrolled in marketplace plans will see varying impacts depending on their insurer, plan, and income level.
As in Arkansas, the driving force behind Pennsylvania’s premium spike is the anticipated loss of enhanced federal subsidies. These credits, passed in 2021 as part of COVID-19 relief, are set to expire at the end of 2025. Without them, many working-class families, rural residents, and older adults not yet eligible for Medicare could find themselves priced out of coverage. The state’s insurance department has urged consumers to shop carefully during the open enrollment period starting November 1, but the uncertainty around federal action has left many feeling anxious.
For individuals like Lauri Cumming, a 60-year-old Havertown resident and recent cancer survivor, the stakes are painfully clear. Cumming and her husband currently pay about $1,000 per month for their ACA health insurance. Without subsidies, that figure would jump to $1,900—before even factoring in the new premium hikes for 2026. "I’m afraid to look at next year. It’s scary and I don’t know what we’re going to do," she told WHYY News. She’s not alone; small business owners like Andrea Deutsch, who also serves as mayor of Narberth, face wrenching choices between maintaining their livelihoods and affording health coverage for chronic conditions.
North Dakota, too, is grappling with the fallout from the possible expiration of enhanced premium tax credits. Insurance Commissioner Jon Godfread warned on October 16, 2025, that unless Congress acts by December 31, premiums for roughly 30,000 North Dakotans could rise anywhere from $378 to $3,735 next year, depending on income. Godfread told the North Dakota Monitor, "In some cases it could be double, triple or even quadruple what you paid last year." As many as 10,000 residents might opt to go without insurance entirely, according to analyses cited by the Insurance and Securities Department.
Godfread emphasized that the enhanced tax credits, expanded during the pandemic, enabled many farmers, ranchers, and small business owners to afford coverage for the first time. With open enrollment beginning November 1, he fears that the uncertainty could drive consumers away from the marketplace—even if Congress ultimately renews the subsidies before they expire. "If individuals go in and shop and they see this large increase, they may not come back and shop again if Congress acts and extends these subsidies," he said.
The state’s 2026 base rate increases, already approved, will see Medica Health Plan premiums jump by 23.09%, Blue Cross Blue Shield of North Dakota by 8.3%, and Sanford Health Plan by 5.12% for individual plans. Small group market plans will also rise by as much as 8.29%. Godfread lamented, "The cost of receiving health care in the state is continuing to rise. We have to do something to get our health care costs under control. North Dakota is a very high cost state to receive health care."
Advocacy organizations are sounding the alarm as well. The American Cancer Society Cancer Action Network has urged Congress to act quickly, warning that the loss of subsidies could force people undergoing cancer treatment or seeking preventive screenings to forgo coverage. "These tax credits are incredibly important for individuals that are undergoing cancer treatments or are in need of basic health care, health insurance coverage," said David Benson, a senior campaigns manager with the organization.
The political battle over the future of these subsidies has become intertwined with broader government funding disputes. In North Dakota, a federal government shutdown in October 2025 was partly attributed to disagreements over renewing the enhanced tax credits. Senate Democrats have insisted on including an extension as part of any stopgap spending bill, while some Republicans argue the issues should be addressed separately. Representative Julie Fedorchak stated, "This issue does need to be addressed, and it will be addressed. But I think it’s also very important to recognize that premiums have been skyrocketing, even with these premium tax credits." Senator Kevin Cramer accused Democrats of shutting down the government to "score political points," insisting that "these major health care policy changes Senate Democrats are demanding should be negotiated through the legislative process, not a short-term continuing resolution."
Despite the political wrangling, the reality for consumers is stark. Without swift federal action, millions across the country could face unaffordable premiums or lose coverage altogether. State regulators and insurance commissioners are urging Congress to extend the enhanced tax credits, even as they acknowledge that deeper reforms are needed to rein in the underlying cost of health care. As Commissioner Godfread put it, "You can’t really have a meaningful discussion on ‘how do we bring down the cost of health insurance?’ without having a meaningful discussion on ‘how do you bring down the cost of health care services?’"
The coming months will test whether lawmakers can bridge their differences in time to prevent a wave of insurance losses and financial hardship for families already stretched to the limit. For now, the message from state officials and advocates is clear: the clock is ticking, and the stakes couldn’t be higher for Americans’ health and financial security.
