Marketplace Pulse: Marketplace Premium Increases Get Real in Idaho as Open Enrollment Begins

The Marketplace Pulse series provides expert insights on timely policy topics related to the health insurance marketplaces. The series, authored by RWJF Senior Policy Adviser Katherine Hempstead, analyzes changes in the individual market; shifting carrier trends; nationwide insurance data; and more to help states, researchers, and policymakers better understand the pulse of the marketplace.

With ACA open enrollment now underway in Idaho, state residents are the first in the nation to directly experience the impact of the expiration of enhanced Premium Tax Credits (ePTCs). The massive premium increases that have been projected nationwide have become a reality, with the average Idahoan being asked to pay approximately twice as much  for their health insurance in 2026, with those at the bottom and top of the income distribution spectrum seeing the biggest impacts. A standoff in Congress over extending the credits is at an impasse and has resulted in a federal government shutdown, with no solution in sight and the beginning of open enrollment in most states less than two weeks away. But in Idaho, these theoretical outcomes have become real for the nearly 80,000 residents of this small state that count on the ACA Marketplace for their coverage.

For enrollees hoping to adjust to the change by dropping from a silver to a bronze plan, most in Idaho will find that they will save little or nothing on their premiums, even while switching to a plan that has much higher out-of-pocket obligations. The loss of the ePTCs is so significant that even enrolling in a bronze plan with a lower actuarial value will not be enough to prevent a monthly premium increase for consumers. For example, in the majority of Idaho’s rating areas, the lowest cost 2026 bronze plan for a 40 year old at 250% of the federal poverty level (FPL) will cost more than the least expensive silver plan if the ePTCs are extended. Figure 1 shows the 2026 premiums for the least expensive bronze plan with ACA tax credits and the least expensive silver plan with ePTCs in the largest zip code in each county in Idaho.

Figure 1: PY 2026, Age 40, 250% FPL, Low Bronze Premium With ePTCs Compared to PY 2026 Low Silver Premium With ACA Tax Credits

Table 1: PY 2026, Age 40, 250% FPL, Share of Premium Covered by Tax Credits (ACA versus ePTCs) and Monthly Subsidized Premium – Idaho County (Zip Code - 83530)

For those earning above 400% of the FPL, the expiration means the difference between having a tax credit and not having one—in other words, a return to the “subsidy cliff”. For example, for a 60-year- old enrollee with an income that is 402% of the FPL, roughly $63,000 annual income, premiums will increase by more than 100% in every county—with monthly premiums increasing from $446 to more than $1,000. The unsubsidized annual premiums would constitute roughly 20% of pre-tax income for these enrollees, which excludes additional out-of-pocket spending that is required most of the time when care is received.

Table 2: PY 2026, Age 60, 402% FPL, Share of Premium Covered by Tax Credits (ACA versus ePTC) and Monthly Subsidized Premium – Idaho County (Zip – Code 83530)

The failure to extend these enhanced tax credits will translate into increased uninsurance. Nationally, the Congressional Budget Office (CBO) projects nearly five million people will become uninsured if the enhanced PTCs expire. In Idaho, the uninsured rate is expected to increase by 9%.  Losing coverage not only has serious health and financial consequences for individuals and families, but has ripple effects that impact local economies, small businesses, and healthcare providers.

If the credits do expire and consumer costs spike, healthier people are likely to drop their coverage and go uninsured, which will raise costs for everyone. Not surprisingly, the size of the marketplace is predicted to contract sharply. In Idaho, there will be an estimated decline of 38% in Marketplace enrollment. While it is not too late for Congress to act, in Idaho it will be impossible to completely un-ring the bell, as many shoppers, once discouraged, will not return to the marketplace. 

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