NEW YORK (AP) — Enhanced tax credits that have helped reduce the cost of health insurance for the vast majority of Affordable Care Act enrollees expired overnight, cementing higher health costs for millions of Americans at the start of the new year.
Democrats forced a 43-day government shutdown over the issue. Moderate Republicans called for a solution to save their 2026 political aspirations. President Donald Trump floated a way out, only to back off after conservative backlash.
In the end, no one’s efforts were enough to save the subsidies before their expiration date. A House vote expected in January could offer another chance, but success is far from guaranteed.
The change affects a diverse cross-section of Americans who don’t get their health insurance from an employer and don’t qualify for Medicaid or Medicare — a group that includes many self-employed workers, small business owners, farmers and ranchers.
It comes at the start of a high-stakes midterm election year, with affordability — including the cost of health care — topping the list of voters’ concerns.
“It really bothers me that the middle class has moved from a squeeze to a full suffocation, and they continue to just pile on and leave it up to us,” said 37-year-old single mom Katelin Provost, whose health care costs are set to jump. “I’m incredibly disappointed that there hasn’t been more action.”
The expired subsidies were first given to Affordable Care Act enrollees in 2021 as a temporary measure to help Americans get through the COVID-19 pandemic. Democrats in power at the time extended them, moving the expiration date to the start of 2026.
With the expanded subsidies, some lower-income enrollees received health care with no premiums, and high earners paid no more than 8.5% of their income. Eligibility for middle-class earners was also expanded.
On average, the more than 20 million subsidized enrollees in the Affordable Care Act program are seeing their premium costs rise by 114% in 2026, according to an analysis by the health care research nonprofit KFF.
Those surging prices come alongside an overall increase in health costs in the U.S., which are further driving up out-of-pocket costs in many plans.
Some enrollees, like Salt Lake City freelance filmmaker and adjunct professor Stan Clawson, have absorbed the extra expense. Clawson said he was paying just under $350 a month for his premiums last year, a number that will jump to nearly $500 a month this year. It’s a strain for the 49-year-old but one he’s willing to take on because he needs health insurance as someone who lives with paralysis from a spinal cord injury.
Others, like Provost, are dealing with steeper hikes. The social worker’s monthly premium payment is increasing from $85 a month to nearly $750.
Health analysts have predicted the expiration of the subsidies will drive many of the 24 million total Affordable Care Act enrollees — especially younger and healthier Americans — to forgo health insurance coverage altogether.
Over time, that could make the program more expensive for the older, sicker population that remains.
An analysis conducted last September by the Urban Institute and Commonwealth Fund projected the higher premiums from expiring subsidies would prompt some 4.8 million Americans to drop coverage in 2026.
But with the window to select and change plans still ongoing until Jan. 15 in most states, the final effect on enrollment is yet to be determined.
Provost, the single mother, said she is holding out hope that Congress finds a way to revive the subsidies early in the year — but if not, she’ll drop herself off the insurance and keep it only for her four-year-old daughter. She can’t afford to pay for both of their coverage at the current price.
Last year, after Republicans cut more than $1 trillion in federal health care and food assistance with Trump’s big tax and spending cuts bill, Democrats repeatedly called for the subsidies to be extended. But while some Republicans in power acknowledged the issue needed to be addressed, they refused to put it to a vote until late in the year.
In December, the Senate rejected two partisan health care bills — a Democratic pitch to extend the subsidies for three more years and a Republican alternative that would instead provide Americans with health savings accounts.
In the House, four centrist Republicans broke with GOP leadership and joined forces with Democrats to force a vote that could come as soon as January on a three-year extension of the tax credits. But with the Senate already having rejected such a plan, it’s unclear whether it could get enough momentum to pass.
Meanwhile, Americans whose premiums are skyrocketing say lawmakers don’t understand what it’s really like to struggle to get by as health costs ratchet up with no relief.
Many say they want the subsidies restored alongside broader reforms to make health care more affordable for all Americans.
“Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it,” said Chad Bruns, a 58-year-old Affordable Care Act enrollee in Wisconsin. “They need to get to the root cause, and no political party ever does that.”
FILE - A lectern awaits the arrival of House Democrats to speak on the health care funding fight on the steps of the House at the Capitol in Washington, Nov. 12, 2025. (AP Photo/J. Scott Applewhite, File)
CRANS-MONTANA, Switzerland (AP) — A fire ripped through a bar’s New Year celebration in a Swiss Alpine resort less than two hours after midnight Thursday, with dozens of people feared dead and about 100 more injured, most seriously, police said.
The Crans-Montana resort is best known as an international ski and golf venue and overnight its crowded Le Constellation bar morphed from a scene of revelry into the site of potentially one of Switzerland’s worst tragedies.
“Several tens of people” were killed at the bar, Valais Canton police commander Frédéric Gisler said during a news conference.
Work is underway to identify the victims and inform their families but “that will take time and for the time being it is premature to give you a more precise figure," Gisler said, adding that the community is “devastated.”
Beatrice Pilloud, Valais Canton attorney general, said it was too early to determine the cause of the fire. Experts have not yet been able to go inside the wreckage.
“At no moment is there a question of any kind of attack,” Pilloud said.
Helicopters and ambulances rushed to the scene to assist victims, including some from different countries, officials said.
Two women told French broadcaster BFMTV that they were inside when they saw a barman carrying a barmaid on his shoulders. The barmaid was holding a lit candle in a bottle that set fire to the wooden ceiling. The flames quickly spread and collapsed the ceiling, they told the broadcaster.
One of the women described a crowd surge as people frantically tried to escape from a basement nightclub up a narrow flight of stairs and through a narrow door.
Another witness speaking to BFMTV described people smashing windows to escape the blaze, some gravely injured, and panicked parents rushing to the scene in cars to see whether their children were trapped inside. The young man said he saw about 20 people scrambling to get out of the smoke and flames and likened what he saw to a horror movie as he watched from across the street.
Officials described how the blaze likely triggered the release of combustible gases that ignited violently and caused what English-speaking firefighters call a flashover or backdraft.
“This evening should have been a moment of celebration and coming together, but it turned into a nightmare,” said Mathias Rénard, head of the regional government.
The injured were so numerous that the intensive care unit and operating theater at the regional hospital quickly hit full capacity, Rénard said.
Crans-Montana is less than 5 kilometers (3 miles) from Sierre, Switzerland, where 28 people including many children were killed when a bus from Belgium crashed inside a Swiss tunnel in 2012.
In a region busy with tourists skiing on the slopes, the authorities have called on the local population to show caution in the coming days to avoid any accidents that could require medical resources that are already overwhelmed.
With high-altitude ski runs rising around 3,000 meters (nearly 9,850 feet) in the heart of the Valais region's snowy peaks and pine forests, Crans-Montana is one of the top venues on the World Cup circuit. The resort will host the best men’s and women’s downhill racers, including Lindsey Vonn, for their final events before the Milan Cortina Olympics in February. The town's Crans-sur-Sierre golf club stages the European Masters each August on a picturesque course.
The Swiss blaze on Thursday came 25 years after an inferno in the Dutch fishing town of Volendam on New Year’s Eve, which killed 14 people and injured more than 200 as they celebrated in a cafe.
Swiss President Guy Parmelin said in a social media post that the government’s “thoughts go to the victims, to the injured and their relatives, to whom it addresses its sincere condolences.”
Thursday was Parmelin’s first day in office as the seven members of Switzerland’s government take turns holding the presidency for one year. Out of respect for the families of the victims, he delayed a traditional New Year address to the nation meant to be broadcast Thursday afternoon, Swiss broadcasters SRF and RTS reported.
Dazio reported from Berlin and Leicester reported from Paris. Geir Moulson in Berlin and Graham Dunbar in Geneva contributed to this report.
From left, Mathias Reynard, State Councillor and president of the Council of State of the Canton of Valais, Stephane Ganzer, State Councillor and head of the Department of Security, Institutions and Sport of the Canton of Valais, Frederic Gisler, Commander of the Valais Cantonal Police and Beatrice Pilloud, Attorney General of the Canton of Valais during a press conference in Lens, following a fire that broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
Police officers inspect the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Jean-Christophe Bott/Keystone via AP)
From left, Mathias Reynard, State Councillor and president of the Council of State of the Canton of Valais, Stephane Ganzer, State Councillor and head of the Department of Security, Institutions and Sport of the Canton of Valais, Frederic Gisler, Commander of the Valais Cantonal Police, Beatrice Pilloud, Attorney General of the Canton of Valais and Nicole Bonvin-Clivaz, Vice-President of the Municipal Council of Crans-Montana during a press conference in Lens, following a fire that broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
A skier walks in the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
A banner stating that fireworks are prohibited due to the risk of fire is pictured near the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
Police officers inspect the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
Police officers inspect the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
Police officers inspect the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
Police officers inspect the area where a fire broke out at the Le Constellation bar and lounge leaving people dead and injured, during New Year’s celebration, in Crans-Montana, Swiss Alps, Switzerland, Thursday, Jan. 1, 2026. (Alessandro della Valle/Keystone via AP)
