The expiration of enhanced tax credits put affordable coverage further out of reach
DES MOINES, Iowa — As open enrollment for Affordable Care Act (ACA) Marketplace coverage begins November 1, Iowans are facing another year of rising health care costs. After the health care tax credits expired at the end of 2025, many families are paying more for coverage, while proposed premium increases for 2027 threaten to add further pressure to household budgets. These credits helped make monthly premiums more affordable for millions of Americans, including Iowa farmers, small-business owners, and people who purchase insurance independently.
Iowa Marketplace insurers increased premiums by an average of 15.3% for 2026. For 2027, insurers have proposed additional increases, including hikes of nearly 14% from Avera Health Plans and approximately 12% from Oscar and UnitedHealthcare. Iowa Total Care has proposed an increase of nearly 17%. These rates were proposed and remain subject to approval.
Cheryl, a small-business owner who runs a farm and bakery with her husband, experienced firsthand how difficult it can be to afford ACA coverage. She continues to feel the effects of a health care system that leaves families uncertain about whether they can afford the care they need.
“This is what a fractured system looks like up close. When Medicaid is cut and you lose tax credits that keep coverage affordable, real people end up stuck, wondering if they'll get the care they need,” Cheryl said.
In July 2025, Representatives Mariannette Miller-Meeks and Zach Nunn voted for the Republican Tax Law, which cut Medicaid. Republicans in Congress, including Miller-Meeks, allowed the health care tax credits to expire. Together, these developments have raised concerns about affordability and access to coverage for people who rely on the individual insurance market and public health programs.
As Iowans compare plans during open enrollment, the cost of coverage remains a central concern. Open enrollment runs from November 1, 2026, through January 15, 2027, through HealthCare.gov. Iowans who want coverage to begin January 1 need to enroll by December 15.