Marketplace subsidy enhancements which have been in place since 2021 are set to expire at the end of December 2025, and their fate is currently uncertain. Since 2014, when Affordable Care Act (ACA) Marketplaces were established, most Marketplace enrollees have received premium tax credits (PTCs) that make plans more affordable. In 2021, the American Rescue Plan Act increased PTC amounts and extended them to people whose incomes were previously above the eligibility threshold, and in 2022, the Inflation Reduction Act extended the enhancements until the end of 2025. Recent Urban Institute analysis found that if the PTC enhancements are not extended, 4.8 million more people would be uninsured in 2026 and net premiums would rise steeply. Whether to extend the enhancements was the key point of contention in the government shutdown.
Under the subsidy enhancements and accompanying policies aimed at easing access to Marketplace coverage, Marketplace enrollment more than doubled between 2020 and 2024 and increased by over a million among children. A new Urban Institute brief finds that Marketplace coverage has become an increasingly important part of the health insurance landscape for families with children. In 2025, 4.8 percent of parents and 3.4 percent of children had Marketplace coverage according to the Current Population Survey, and 5.9 percent of parents and 3.1 percent of children had Marketplace coverage in 2024 according to the National Health Interview Survey. In these surveys, the share of parents relying on Marketplace coverage rose by 33-48 percent since 2019, and the share of children relying on Marketplace coverage rose by 48-59 percent. According to these survey data, children and parents together now account for approximately 4 in 10 of all nonelderly Marketplace enrollees.
Marketplace enrollment among children is at record highs and nearly as high as separate Children’s Health Insurance Program (CHIP) enrollment
According to administrative data on Marketplace plan selections, a record 2.6 million children were enrolled in Marketplace coverage at the end of 2024. Thus, Marketplace enrollment was approaching the number of children enrolled in separate CHIP coverage (not including CHIP children enrolled through Medicaid). The growth in Marketplace enrollment over the last several years has made subsidized Marketplace coverage a key source of health insurance for children.
Marketplace coverage is especially critical for parents in states that did not expand Medicaid
Marketplace coverage is even higher among parents than children. And according to the 2025 Current Population Survey, parents in states that have not expanded Medicaid under the ACA were much more likely to have Marketplace coverage than parents in expansion states – at 7.1 percent in nonexpansion states, compared with close to 4 percent in both states that expanded Medicaid before 2019 and those that expanded since then. Parents in nonexpansion states experienced the largest increases in Marketplace coverage between 2019 and 2025, rising from 4.6 percent to 7.1 percent.
Loss of Marketplace coverage would lead to more children and parents going without the health care they need
Millions of Marketplace enrollees are projected to lose Marketplace coverage in 2026 if the enhanced PTCs expire. Of the 4.8 million more nonelderly people who would become uninsured, 453,000 are children.
Losing Marketplace coverage and becoming uninsured would reduce receipt of needed health care and worsen access to care among families with children. Our analysis showed that parents and children with Marketplace coverage had much better levels of access to and use of health care relative to similarly situated people who were uninsured. And expiration of enhanced subsidies would not only cause many to become uninsured. For those who would maintain Marketplace plans, premiums would rise, often quite steeply, which would make it more difficult for families to afford other basic needs like housing, utilities, food, and child care.
Along with experiencing coverage losses under the expiration of the subsidy enhancements, families are also facing risks of losing coverage as Medicaid and Marketplace provisions of H.R. 1 are implemented. At the same time, millions of families are facing loss of all or some of their Supplemental Nutrition Assistance Program (SNAP) benefits and experiencing increases in costs for everyday expenses. Discontinuing enhanced subsidies could exacerbate material hardships, adversely affecting the health and wellbeing of children now and as they grow.