In less than 18 months, more than 24 million Americans could see their health insurance premiums increase by an average of 93% unless Congress acts to extend federal tax credits established under the ACA, according to Eduardo Conrado, president of St. Louis-based Ascension.
“This is both predictable and preventable,” Mr. Conrado said in a Sept. 5 blog post.
The subsidies — expanded during the pandemic and set to expire in January — have helped millions of working- and middle-class families afford coverage. Their loss would leave families facing painful choices between maintaining insurance or paying for other necessities.
The ACA tax credits have reduced monthly premiums by nearly half, according to Ascension. More than 9 million people currently pay $10 or less per month for health plans, a level of affordability that has stabilized coverage and kept families from falling into medical debt, which is the leading cause of personal bankruptcy in the U.S.
Mr. Conrado said the credits do more than lower costs: they improve health outcomes by expanding access to preventive care. Insured adults are nearly twice as likely to receive recommended cancer screenings, and families with coverage are more likely to access behavioral health services and primary care before conditions worsen.
If the tax credits expire, 5 million people could lose coverage altogether, while those who remain insured would face steep annual premium increases:
- A family of four earning $125,000: +$7,700
- A family of four earning $64,000: +$2,600
- A 60-year-old couple earning $80,000: +$17,500
“These costs will be felt across the healthcare system,” Mr. Conrado wrote, noting that higher premiums will strain family budgets and further destabilize hospitals.
House Republicans have proposed a stopgap funding bill that would keep federal agencies operating through Nov. 21, but the measure does not include an extension of the enhanced ACA premium tax credits. The bill, if passed, would avert a government shutdown on Oct. 1. Republican leaders plan to call a floor vote later this week.
Health system leaders warn the expiration of subsidies would have consequences beyond affordability. Emergency department visits could surge, exacerbating provider burnout and raising costs for all patients, according to Jacquelyn Bombard, associate vice president and chief federal affairs officer for Renton, Wash.-based Providence.
“This isn’t just a policy change that’s going to impact a subset of individuals. It’s going to impact all of us,” Ms. Bombard told Becker’s. “We all have a stake in this because it’s going to upend the health system.”
Providence, a 51-hospital Catholic system, said that in some states it serves — such as California, where 40% of the population is eligible for Medicaid — up to 20% of residents could lose coverage if the subsidies lapse, compounding the effects of proposed Medicaid cuts. Overall, as much as 40% of the population in affected states could lose access, shifting risk pools, driving up premiums, and destabilizing rural hospitals already on thin margins.
“The status quo is not sustainable,” Ms. Bombard said. “If we don’t extend these subsidies, it’s going to dismantle our health system — and every patient, every provider and every community is going to feel that.”
Ascension and Providence both emphasized that more insured patients means less strain on emergency departments, more predictable revenue for providers and healthier communities overall.
“Preserving the healthcare tax credits is not just about policy. It is about protecting families from financial hardship, maintaining continuity of care, and strengthening the health of communities across the country,” Mr. Conrado wrote. “Congress has a choice. Allowing these credits to expire is the same as raising taxes on millions of families while weakening the healthcare system and the communities they serve. Extending them is a key step to support healthier families, stronger communities, and a more stable nation.”
