The implications of actions by the Trump administration and congressional leadership are becoming increasingly clear: overall private health insurance marketplace premiums will climb at the same time as health care tax credits fall. This “double whammy” will disproportionately affect rural Americans.
Specifically, new rules, tariffs, legislation, and inaction have contributed to the highest median proposed premium hikes for the individual market in the past five years: 18 percent as of August 6, 2025.
At the same time, the scheduled drop in tax credits for health insurance marketplace premiums in January 2026 will increase out-of-pocket premiums by an average of 93 percent in HealthCare.gov states.
According to this new analysis by The Century Foundation of thirty-two states, rural Americans will be disproportionately affected by imminent changes to marketplace coverage.
- Out-of-pocket premiums will increase on average by 107 percent for rural county residents compared to 89 percent for urban county residents—on top of national median increases of 18 percent.
- While all people with premium tax credits will pay more for health care, rural residents’ average cost increase will be 28 percent higher than that of urban residents.
- Rural residents in fourteen of the thirty-two states using HealthCare.gov will lose on average over $1,000 annually in premium tax credits.
- 2.8 million enrollees in HealthCare.gov marketplace plans live in rural counties and are at greater risk than urban enrollees of higher prices and loss of coverage; this includes 776,000 adults ages 55 to 64 and 223,262 children.
- While two of the states using HealthCare.gov have more rural than urban residents, sixteen have a higher percentage of rural than urban non-elderly residents enrolled in HealthCare.gov plans. Of those sixteen states, seven have more than one in ten of their non-elderly rural residents enrolled in HealthCare.gov plans.
- Looking at both premium increases and reliance on marketplace coverage, rural residents in states in the Upper Midwest and Southeast are at greatest risk of high prices and loss of health coverage due to recent changes in health policy.
Download the fact sheet here.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Rural Americans Face Unprecedented Price Hikes for Health Care
The implications of actions by the Trump administration and congressional leadership are becoming increasingly clear: overall private health insurance marketplace premiums will climb at the same time as health care tax credits fall. This “double whammy” will disproportionately affect rural Americans.
Specifically, new rules, tariffs, legislation, and inaction have contributed to the highest median proposed premium hikes for the individual market in the past five years: 18 percent as of August 6, 2025.
At the same time, the scheduled drop in tax credits for health insurance marketplace premiums in January 2026 will increase out-of-pocket premiums by an average of 93 percent in HealthCare.gov states.
According to this new analysis by The Century Foundation of thirty-two states, rural Americans will be disproportionately affected by imminent changes to marketplace coverage.
Download the fact sheet here.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5