(NewsNation) — More than 20 million Americans rang in the new year with uncertainty as Affordable Care Act subsidies expired at midnight.

Without those subsidies, which help mitigate the cost of private health insurance, premiums could more than double in 2026 for 24 million Americans, according to a preview of the available plans released by the Trump administration.

Lawmakers have fought over the subsidies for months, with countless failed proposals failing to gain Congressional approval and fueling the nation’s longest-ever government shutdown.

Patrick Casale, president of the MultiCare Group, told NewsNation that some of his employee benefit consultations involve people seeking an affordable way forward.

“I’ve had clients complain they’re going to drop their insurance 100%, I’ve had clients ask me for alternatives,” Casale said. “And they were shocked to learn the alternatives are no better than the plan they are currently on.”

Nearly half of American adults, 47%, are worried they won’t be able to afford necessary health care, according to a West Health-Gallup poll from November. Participants reported the highest level of concern around health care in the last four years.

ACA subsidies have expired. What comes next?

Though the deadline has passed, Congress can still reverse some of the expected cost increases after its winter break. Lawmakers will return on Jan. 2.

The House could vote on a three-year extension within weeks. But even if an extension passes through that chamber, the proposal faces even more uncertainty in the Senate.

Lawmakers may also try to compromise on a short-term subsidy extension, though that would face an uphill battle at the Capitol as well.

New year brings new SNAP junk food policy

The new year also marks major policy changes for some Americans who benefit from the Supplemental Nutrition Assistance Program.

Starting in 2026, more than a million people living in Indiana, Iowa, Nebraska, Utah and West Virginia who receive SNAP benefits are now prohibited from using their food stamps on certain items like soda, candy and energy drinks.

Health Secretary Robert F. Kennedy Jr. has pushed to reduce chronic diseases like obesity and diabetes, which are associated with sodas and foods generally described as unhealthy.

The National Retail Federation says the new changes may lead to longer lines and more customer complaints as SNAP recipients learn which foods are affected.

NewsNation’s Brooke Shafer and partner The Hill contributed to this report.