Marketplace Pulse: Off the Cliff in Farm Country
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.
The expiration of the Affordable Care Act’s (ACA) enhanced premium tax credits (ePTCs) will have its greatest impact in rural America, where a higher share of the population depends on the ACA for health coverage, and healthcare costs are already higher.
Older, self-employed, rural enrollees–many of whom were farmers or ranchers or otherwise engaged in agriculture–benefited greatly from the ePTCs, particularly the elimination of the "subsidy cliff." By extending tax credits above the 400% federal poverty level (FPL) income cut off, coverage became affordable for many older enrollees in high-cost rural states.
This increased affordability is quickly coming to end as there is no plan to extend the ePTCs past the end of this year. When rural residents go to the marketplace to re-enroll in coverage for 2026, they will be confronted with eye-popping increases in premiums, particularly if they happen to be older and on the other side of the subsidy cliff. Enrollees over 400% FPL will lose their entire tax credit and be asked to pay the full price of their health insurance, which will sometimes cost close to 20% of their income, just for the premiums.
Last year we provided an overview of how important the ACA marketplace is to people in leading farm states. Here we update some of those statistics and share an interactive map that shows small area data on tax credit loss in rural and urban areas.
In 2025, 1.2 million residents in these 10 states chose a marketplace plan, and 92% of enrollees used a tax credit. The average tax credit was $565, reducing the average monthly premium to $92.
These tax credits will be smaller in 2026, and for the 111,000 enrollees with incomes above 400% FPL, they will disappear completely.
For another perspective on rural residents losing their tax credits, the map linked below shows what happens to the tax credit for the lowest silver plan throughout healthcare.gov states.
For example, a 40-year-old living in Cheyenne, Wyoming with an income of 402% of the federal poverty will lose their entire $583 tax credit, and be asked to pay $1,026 per month for a silver plan or $740 for a bronze plan. A Rapid City, South Dakota resident will lose a tax credit of $329 and pay $761 for a silver plan or $540 for a bronze plan. A resident of Marquette, Michigan will face similar prices. At an income of roughly $62,000, premiums of $1,000 per month are approximately 20% of pre-tax income, and this does not include the non-trivial cost sharing that will accompany these plans. Many in the public sphere have implied that tax credits for those earning over 400% FPL are some type of boondoggle for millionaires. But the facts tell a different story, and many rural residents will soon face an impossible price for coverage.
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