Rising costs and congressional inaction mean countless women are entering 2026 without health coverage they can afford.
With the 2026 Affordable Care Act (ACA) open enrollment period now closed, millions of Americans are facing an uncomfortable new reality: higher monthly costs for the health coverage they already struggled to afford.
Because congressional Republicans failed to extend the ACA’s enhanced premium tax credits, they expired at the end of 2025 and triggered the return of a catastrophic “subsidy cliff.” Since 2021, these credits have helped millions of Americans, especially women, afford their monthly premiums. In fact, in the first year of the enhanced tax credits, women’s enrollment in the ACA Marketplace increased more than 18 percent from around 6.5 million to 7.8 million, and by 2025, women’s enrollment reached nearly 12.7 million.
Now, many people will pay hundreds, and in some cases even thousands, more per year for the exact same coverage. ACA enrollees with a household income that exceeds 400 percent of the federal poverty level (around $62,000 for an individual in 2025) will no longer qualify for any help at all.
As a result, the healthcare affordability crisis could be particularly burdensome for women, who are often the ones making health insurance decisions for themselves and their families. In fact, rising premiums and subsidy uncertainty are already reshaping women’s access to care and their economic stability. When health insurance becomes unaffordable, women may be likely to delay care, drop coverage and absorb costs that not only affect them but ripple through their families and communities.
When health insurance becomes unaffordable, women don’t just absorb the cost. They make sacrifices—often at the expense of their health.
When coverage becomes unaffordable, women often respond by cutting back on care first. Evidence suggests that women are more likely than men to skip care because of cost. Half of women say they’ve delayed care they needed, compared to about one-third of men (37 percent). They end up skipping preventive services, delaying medical tests, forgoing mental healthcare, and leaving prescriptions unfilled. The consequences can be severe: delayed diagnoses, worsened health outcomes, poorer quality of life, and higher costs down the road for families and the health system.
Unable to wait for Congress to act to extend the credits, the vast majority of Americans have already made their health insurance decisions for 2026. With the enrollment deadline passed, women have had to make decisions based on what they can afford right now—not on promises that may never materialize.
… Women are more likely than men to skip care because of cost. Half of women say they’ve delayed care they needed …
Some women will be hit especially hard by the cost increase. Individuals who are ages 50-64 are too young for Medicare but are likely to have higher healthcare needs and higher baseline costs could see some of the steepest premium hikes. Women managing chronic health conditions may rely on regular care and medication they can’t afford without insurance. Single mothers and caregivers have little room to absorb higher premiums. And finally, self-employed women, freelancers and small business owners—who are disproportionately represented in the individual insurance market—have no coverage to fall back on. For these groups, even modest premium increases can force impossible tradeoffs between healthcare and other basic needs.
We are already seeing the results of Congress failing to act. Early reporting from CMS shows that these tradeoffs are already driving people out of coverage. Data shows that 22.8 million consumers had signed up for 2026 individual market health insurance—roughly 800,000 fewer enrollees than the same time last year. This is just the tip of the iceberg as enrollment losses are likely to grow in the coming months.
Unable to wait for Congress to act to extend the credits, the vast majority of Americans have already made their health insurance decisions for 2026.
Structural inequities make women more vulnerable when healthcare coverage becomes more expensive. Women are more likely to work part-time, take breaks from the workforce to care for children or family members or work in jobs without health benefits. All of this makes it harder to get affordable coverage through an employer.
Young women, women of color, LGBTQ+ people and women building careers outside traditional 9-to-5 workplaces are especially dependent on the ACA marketplaces. When it becomes unaffordable, there often isn’t another option, so going uninsured becomes the default.
The policy outcomes are clear. The enhanced tax credits contributed to historic marketplace enrollment with more than 24 million Americans selecting plans in 2205, and played a key role in reducing the national uninsured rate. This is especially true for women and low- and middle-income households, the majority of whom were able to select a health plan with a monthly premium of $10 or less after the tax credit.
The healthcare affordability crisis is already pushing women out of care, and the damage from premium shocks is already underway. When coverage becomes unaffordable, women lose access to care, stability and opportunities. Affordable coverage is vital to women’s health and their families’ health and economic security. Congress had a choice, but for the millions of women making enrollment decisions for themselves and their families, that choice was taken from them. Women are paying the price.
