Congress and the Trump Administration have created a major cliff for students’ health insurance. Yesterday, the U.S. Senate voted down a bill to extend expiring health insurance subsidies that 24 million Americans rely on for plans they’ve purchased under the Affordable Care Act (ACA, sometimes called “Obamacare”).
Many now predict that the enhanced subsidies will expire for 2026 health plans, absent a last-minute surprise in Washington, DC, leading to a dramatic drop in coverage nationwide and further worsening of basic needs insecurity. If the enhanced subsidies do lapse, health premiums would more than double on average, rising by more than $1,000 for the typical marketplace enrollee. The Urban Institute projects that 4.8 million people will lose health coverage next year if the enhanced ACA subsidies expire.
Using calculations from a Government Accountability Office (GAO) report released earlier this year, we estimate that nearly one million students are enrolled in marketplace plans and could be affected by the loss of subsidies next year (more on our methodology, below).
Numerous studies have documented that both undergraduate and graduate & professional students rely on health care made possible by the ACA; the GAO noted that, 15 years after the landmark law was passed, the uninsured rate for students was more than cut in half. A similar analysis by The Century Foundation found the same.
The vast majority of people who purchase their health coverage through health insurance marketplaces have been receiving enhanced subsidies toward their insurance premiums since they were enacted during the COVID-19 pandemic (and later temporarily extended).
These subsidies have been set to expire at the end of 2025. “Open enrollment” for marketplace plans, when people can shop for coverage, began on November 1 of this year. That’s when many enrollees first started to see the projected spike in their premiums.
Open enrollment lasts through January 15, 2026—less than 5 weeks away—and many states are already reporting sharp declines in enrollment and renewals. A pitched battle over the subsidies ensued during the recent government shutdown, but no bipartisan deal has been reached. Democrats have generally pushed to extend ACA subsidies, while some Republicans have backed a plan to expand health savings accounts.
Not all students who have their own health insurance purchase that coverage through a marketplace, but the widespread loss of subsidies and the inability to afford insurance could deeply undermine many students’ ability to get timely physical and mental health care. Student basic needs insecurity will skyrocket among those who lose coverage.
Due to the current Congressional majority’s unprecedented $1 trillion in cuts to Medicaid under the One Big Beautiful Bill Act (OBBB) and their staunch resistance to extending the current ACA subsidies, health insurance coverage rates may continue to decline dramatically in the coming years.
Additionally, the family members of some students—such as a spouse, partner, child, parent, or other adult in a caregiving situation—could rely on health insurance coverage that is now at risk. If these family members lose coverage, the students in these households could experience the financial pressure, too—especially with any unexpected health expense that could arise. A significant number of students are also caregivers.
And GAO found that different groups of students have very different levels of coverage, with American Indian, Alaska Native, and Hispanic or Latino students having the highest uninsured rates. Lack of affordable ACA plans could further widen attainment gaps among already systemically marginalized groups.
We know that many students already struggle to afford their basic needs. Survey results, including The Hope Center’s own Student Basic Needs Survey, show that 3 in 5 students do not have enough to eat or a safe place to live. The Student Financial Wellness Survey by Trellis Strategies finds that more than half of undergraduate students would have trouble finding $500 in an emergency—a threshold that health expenses commonly exceed.
The latest data from the Healthy Minds Survey shows that, while rates are steadily improving, 37% of students experience moderate to severe depression. Health insurance is essential for affording the high cost of mental health care.
While some students can obtain health coverage from their institutions of higher education, only two-thirds of colleges and universities examined by GAO offer health insurance plans, and even fewer have on-campus health facilities. In many cases, students opt out of their college-sponsored health plans and instead seek insurance through the health insurance exchanges, their employer(s), or Medicaid, and are still at risk from other upcoming policy changes that will wreak havoc on the health care system overall.
Younger students may have the option to stay on their parent(s)’ or spouse’s health insurance plan until age 26. But the average age of today’s undergraduates is 25, and even most younger students are financially independent of their parents. Remaining on a parent or spouse’s health insurance plan is not a realistic option for the vast majority of students today—especially working adults. In fact, 1 in 5 students are parents themselves.
Congress’ failure to extend the expiring ACA subsidies is putting one million students, and countless numbers of their family members and loved ones, at severe risk.
On top of rising prices for everyday goods, most Americans cannot afford a major spike in their health insurance premiums or the unexpected health expenses that could financially devastate them—and send them deep into debt—without insurance.
It is essential that Congress and the White House come together on a bipartisan plan to avoid any major increase in health care costs in 2026 and beyond. Students deserve nothing less.
Methodology: The GAO’s 2025 report noted that, of total fall headcount enrollment of around 19 million students, 92% were insured. Of those who were insured, 12.9% were covered by “direct-purchase” coverage, which could include plans purchased on or off a health insurance marketplace. And of those with direct purchase coverage, 42% purchased plans on the marketplace, while 58% did not. 19,000,000 x .92 x .129 x .42 = 947,066 students.