A combination of Trump administration policies will make health care coverage more expensive for people who purchase plans from health insurance marketplaces — and rural residents will be hit the hardest, according to a new analysis.

Researchers from the Century Foundation say Trump administration policies — especially its refusal to ask Congress to extend Biden-era tax credits that are set to expire at the end of this year — will boost out-of-pocket premiums by 93% in the 32 states that allow the federal government to operate their Affordable Care Act insurance marketplaces. New rules and tariffs will have a smaller impact. Rural county residents in those states will see an increase of 107%, while residents of urban counties will pay 89% more, according to the analysis by the Century Foundation, a left-leaning research nonprofit.

Insurers participating in the Affordable Care Act marketplaces are proposing a median premium increase of 18% for 2026 — the biggest jump since 2018 and 11 points more than the growth from 2024 to this year. That bump would come on top of the increase resulting from the expiration of the tax credits and the other policy changes.

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