Expiring ACA Subsidies Could Reshape the 2026 Midterms — West Virginia Stands to Lose Most

Expiring ACA Subsidies Could Reshape the 2026 Midterms — West Virginia Stands to Lose Most

By Nathan Layne

BECKLEY, West Virginia (Reuters) - The looming expiration of enhanced Affordable Care Act (ACA) subsidies has become both a personal crisis and a political flashpoint in West Virginia, with potential consequences for the 2026 midterm elections.

Local impact and a campaign angle

For Larry Jackson, a 42-year-old business owner and Republican primary challenger who supports Donald Trump, the debate is intimate and electoral. Jackson, who uses the ACA to cover his family of eight, says his monthly premium would jump fourfold to $1,850 if the temporary pandemic-era subsidies lapse at the end of December. He plans to make the expiring tax credits a centerpiece of his campaign to unseat Representative Carol Miller, who has not publicly committed to keeping the subsidies in place.

The subsidies expanded federal assistance for Americans buying coverage through ACA marketplaces during the COVID-19 pandemic and have been a lifeline for many who otherwise could not afford insurance. With an older, predominantly rural population and some of the nation's highest rates of poverty and chronic illness, West Virginia faces among the steepest proposed premium increases in the country if the enhanced credits are not continued.

Political standoff and timing

A recent standoff over extending the subsidies contributed to a 43-day federal government shutdown that ended without a deal to continue the credits. Senate leaders have promised a December vote on the issue, but House Republican leadership has not committed to bringing the measure to the floor, leaving the subsidies' future uncertain.

Public opinion and partisan politics

Local interviews conducted by Reuters found a comfortable majority of West Virginians — including Democrats and several Republicans — favored extending the subsidies while Congress works on a longer-term solution. National polling from KFF (Oct. 27–Nov. 2) suggests broad support as well, with roughly three-quarters of U.S. adults backing continuation of the assistance.

"These tax credits cannot expire. It's going to hurt a lot of people in West Virginia," Jackson told Reuters. "We can all agree there are problems with the Affordable Care Act, but the government needs to extend these credits as they work that out."

Numbers and local consequences

Policy groups warn of dramatic price spikes if the credits end. The Center for American Progress estimates average premium increases of about 387% for ACA enrollees in West Virginia without the enhanced subsidies — the largest projected rise among the states. KFF projects that a 60-year-old couple earning $85,000 in West Virginia’s 1st Congressional District would see premiums jump 654% (about $602) to $4,540, second only to Wyoming.

Insurance agents say lower-income clients are being renewed into plans with rate hikes from roughly 20% to 100%, while those above 400% of the federal poverty line (about $84,600 for a couple) could be priced out entirely if enhanced credits expire. The West Virginia Center on Budget & Policy estimates as many as 15,000 residents could lose coverage because they cannot afford the higher premiums.

State hospitals, which rely heavily on Medicaid, could face additional pressure from planned federal Medicaid reductions included in a package of tax and spending cuts signed by President Trump in July. Jim Kaufman, CEO of the West Virginia Hospital Association, warned the cuts could ultimately cost hospitals about $1 billion a year.

Political calculations at home

Representative Carol Miller has not directly stated whether she would support an extension; her spokesman, Nicolas Gray, said Republicans could negotiate on the credits once the government reopens. The issue has also affected Jackson's own team: his campaign manager, Patrick Krason, said his premiums are projected to rise fivefold to $2,200 and blamed both parties for the impasse.

Analysts say the subsidy fight may not move many votes in deeply Republican states like West Virginia, where Donald Trump won roughly 70% of the 2024 vote, but it could be decisive in competitive, purple districts. Polling and expert commentary suggest Democrats can use the potential premium hikes as a clear line of attack, while Republicans risk being seen as less effective on healthcare unless they produce an alternative plan.

(Reporting by Nathan Layne; editing by Ross Colvin and Bill Berkrot)