Insights

March 22, 2026

How the expiration of enhanced ACA subsidies may impact American families' access to ABA therapy

In December 2025, enhanced Affordable Care Act (ACA) subsidies in the United States ended, putting millions of people’s access to affordable healthcare coverage at risk. Not only did this increase healthcare premiums for those who lost their subsidies, but it also increased premiums across the board - both for marketplace plans and private plans alike. Many saw increases of 20% or more¹. Combined with rapidly increasing cost of living expenses, access to healthcare has suddenly become out of reach for many families. Many of these families are already facing challenging health burdens like chronic illnesses and systemic health disparities. Some families are navigating mental health diagnoses for their children, treatment for which can cost thousands of dollars per year with insurance, and tens of thousands without.

While Applied Behavior Analysis (ABA) remains the subject of debate in some circles, there is substantial evidence that the therapy contributes to significant gains in areas like academic readiness and language². Further, current resources available to families with children with mental health diagnoses are severely lacking relative to the amount of need. I couldn’t tell you the number of times that I’ve spoken with a parent who was either at risk of losing their job, or already had, because their child was forced to leave their daycare. Parents working from home with their child with high needs, simply because there was no other option. Even for parents who know of the available resources, waitlists are just as effective a barrier.

For a lot of these families, ABA is a lifeline. I’ve seen kids gain language who may otherwise have not. Kids who are able to be around their peers and learn enough independence to let their parents attend to other siblings or go grocery shopping. Most of these families are not high-income and depend on affordable healthcare to give their children these opportunities. Going from Gold-level Marketplace plans with subsidized premiums, lower copays, and access to more providers, to lower-level plans or no insurance at all will cause a lot of children to lose ABA therapy. A significant portion of ABA providers require a certain number of hours per week in order to support progress, meaning parents cannot necessarily choose a lighter schedule to save on costs. Any disruption in regular treatment can cause immediate and lasting regression³.

Therapies like ABA, talk therapy, speech therapy, social skills groups, and many more are especially at risk because of their frequency of care. For the best outcomes, these therapies need consistent appointments, unlike services like primary care or specialists, who often only see a patient a handful of times a year. Associated costs for these therapies can be insurmountable, but their services and therapists are an integral part of these families’ lives. The reestablishment and permanent status of enhanced ACA subsidies is one step toward closing this gap in care. Even more so, our communities’ high-needs children and their parents need better wrap-around resources that do not pose such a strain on their pockets. 

The promise of health equity does not have to be a theory, and ensuring a child’s ability to communicate or gain independence should not be dictated by the expiration of a tax credit. Our community’s children are full of potential, and by advocating for the resources and subsidies they need, we are investing in a more equitable and vibrant future.

Works Cited

¹Holahan, J., & O’Brien, C. (2026, January). Putting the Extraordinary Increase in ACA Premiums in 2026 in Perspective. https://www.commonwealthfund.org/blog/2026/putting-extraordinary-increase-aca-premiums-2026-perspective#:~:text=A%20new%20Urban%20Institute%20report,the%20employer%2Dsponsored%20insurance%20market

²Makrygianni, M.K., Gena, A., Katoudi, S., Galanis, P. (2018). The effectiveness of applied behavior analytic interventions for children with Autism Spectrum Disorder: A meta-analytic study. Research in Autism Spectrum Disorders, Volume 51, Pages 18-31. ISSN 1750-9467.

³Choi, K.R., Bhakta, B., Knight, E.A., Becerra-Culqui, T.A., Gahre, T.L., Zima, B., Coleman, K.J. (2022). Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder. J Dev Behav Pediatr. 43(1):9-16. doi: 10.1097/DBP.0000000000000995.