Congress Must Act to Continue Affordable Care Act’s Enhanced Premium Tax Credits

Tuesday, April 15, was the tax filing deadline for most individuals. For those with Premium Tax Credits (PTCs) that help them pay for health insurance through an Affordable Care Act (ACA) Marketplace plan, it’s also a reminder that their access to coverage is at risk. Unless Congress acts in the coming months, low- and middle-income people will see bigger tax and insurance bills in 2026 as COVID-era changes to the PTCs expire.

ACA Lowered the Number of Uninsured

The ACA increased people’s access to affordable health coverage. From 2010—when the ACA was passed—to 2022, the uninsured rate for adults under 65 in the US fell from 17.8% to 9.6%. The number of people getting coverage due to the ACA’s Marketplace, Medicaid expansion, and Basic Health Plans reached 44 million in 2024.

The Role of Premium Tax Credits

A significant part of this surge is due to PTCs. These credits help people with low or middle incomes pay their Marketplace premiums, and they are widely used. In 2024, around 17 million people received PTCs, including nearly five million people between 50 and 64 years old who are not yet eligible for Medicare.

PTCs were expanded during the COVID-19 public health emergency. The American Rescue Plan Act (ARPA) in 2021 increased the amount and availability of the credits and the Inflation Reduction Act (IRA) in 2022 delayed their expiration, but only until the end of 2025.

Without the enhanced PTCs, analysts project ACA premium payments will increase by over 75% on average with a lot of variation between states. The Congressional Budget Office (CBO) estimates that “the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026–2034 period.”

The CBO estimates that “the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026–2034 period.”

A new analysis from AARP and Avalere Health shows the impact this expiration may have on health coverage for people 50–64, including a county-by-county estimate. Avalere estimates that enhanced PTCs currently save the 50+ ACA population a minimum of $599 per year, reaching $4,574 for some enrollees.

Congressional Inaction Will Raise Taxes on Low- and Middle-Income Enrollees

As these numbers show, the enhanced PTCs are vital to keeping people insured. If Congress allows them to expire, they will raise taxes on low- and middle-income people who may no longer be able to afford their health coverage.

At Medicare Rights, we know the value of health insurance coverage and we will work to protect the ACA’s coverage gains. People must have access to high-quality, affordable health care and coverage, especially in times of rising health costs and economic uncertainty.

Further Reading

Read more about trends in lowering the uninsured rate.

Read more about the enhanced PTCs.

Read more about the effect of expiring enhanced PTCs on adults 50-64.