With Sarah Mellott
Editor’s note: This post comes from our data newsletter, the Rural Index, led by Sarah Melotte, the Daily Yonder’s data reporter. Contribute to receive a weekly map or chart straight to your inbox.
In 2026, millions of rural Americans will see their health insurance premiums skyrocket — some by more than $1,300 a month — if Republicans win budget negotiations and end Biden-era insurance subsidies, according to my analysis. data from the Centers for Medicare & Medicaid Services (CMS).
The Senate version of Trump’s budget deal failed to garner enough votes to pass, resulting in a nearly month-long shutdown that began Oct. 1. At the heart of the bill’s failure — and the reason the government hasn’t reopened — is whether to fund the Biden-era health insurance subsidies included in the year-end Inflation Relief Act.
The subsidies lower monthly premiums for consumers who get coverage through private health insurance markets that were was created by the Affordable Care Act (ACA) in 2014. These subsidies were intended to help people who don’t qualify for Medicaid, are too young to get Medicare, and whose employer doesn’t offer a private health insurance plan.
If the GOP cuts funding for these subsidies, enrollees will be forced to either pay for the entire premium out of pocket, if they can afford it, or drop health insurance altogether. In rural Tyler County, West Virginia, for example, the average monthly premium will increase by $1,339 in 2026. In rural Pope County, Illinois, the average monthly premium will increase by $1,258.
More than 2.2 million rural Americans – and 13.8 million urban and suburban Americans – will see their health insurance premiums rise if the GOP wins government shutdown negotiations.
This data comes from the Centers for Medicare and Medicaid Services (CMS), which aggregates data at the state, county, and zip code level. This data set includes only the 31 states that use the federal healthcare.gov health insurance market for consumer enrollment. The data in this analysis comes from the 2025 Open Enrollment Period (OEP), which ran from November 1, 2024 to January 15, 2025.
Initially, health insurance subsidies were available to consumers with incomes between 100% and 400% of the federal poverty level (FPL), approximately $32,000 to $128,000 for a family of four. But the American Bailout Act of 2021 extended these subsidies to Americans living above 400% of FPL, and the Inflation Reduction Act extended these subsidies through the end of 2025. Under the ACA, monthly premiums are capped based on incomewith the federal government covering the rest of the cost.
Compared to their urban counterparts, rural Americans are more likely to live in counties that will see the highest monthly health insurance premiums.
Nearly a quarter of rural Americans live in a county where the average premium increase will be between $659 and $1,339 a month. Only 2% of urban and suburban residents live in counties that will see that level of growth, meanwhile. On the other hand, 41% of metropolitan residents live in counties that will see the lowest increase in premiums — less than $509 a month. However, only 18% of rural residents live in counties in this category.
Rural West Virginia you will see some of the highest premium peaks in the country. All 35 non-metropolitan or rural West Virginia counties are in the fourth quartile with the highest premium peaks. In 33 of those 35 rural counties, the average premium increase will be more than $1,000 a month.
According to the Center on Budget and Policy, 15,000 West Virginians who have health insurance through the marketplace will lose health insurance entirely in 2026 if current health insurance subsidies are not renewed.
Any increase in health insurance premiums is likely to result in a loss of coverage for many Americans. A study found that for every $40 increase in monthly premiums, there was a corresponding one-quarter drop in the low-income enrollee population. Investigations find that cost is the number one reason people don’t sign up for health insurance. According to the Congressional Budget Officethe expiring subsidies will result in 4.2 million enrollees losing health insurance by 2034. Ending these subsidies will hurt Americans across the board, whether they live in a rural or urban area.
Despite the partisan divide in Washington, funding for these subsidies has broad popular approval. A The KFF Health News poll found that 78% Americans believe that Congress should extend market subsidies. In Florida, for example, conservatives have launched a letter writing campaign urging their lawmakers to expand health care subsidies.
This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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Previously Posted at dailyyonder.com with Creative Commons license
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