Congress Must Preserve Access to Affordable Marketplace Coverage

Unless Congress acts soon, critical tax credits that help over 22 million people buy Affordable Care Act (ACA) Marketplace plans will expire at the end of this year, causing premiums and coverage losses to skyrocket.

The Role of Premium Tax Credits

Since 2012, ACA premium tax credits (PTCs) have helped people with low and middle incomes pay their Marketplace premiums. In 2021, The American Rescue Plan Act (ARPA) 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. Notably, while the July 2025 reconciliation bill continued many other tax policies sunsetting this year, it excluded these enhancements.

The PTCs, including the enhancements, are effective and widely used. They help nearly 93% of Marketplace enrollees afford insurance, reducing enrollee premiums from $619 to $113 per month, on average. 

The PTC Enhancements Have Improved Access, Affordability

The PTC enhancements currently in place—and at risk—have had a significant impact. Thanks to these improvements, an estimated seven million more people will be able to afford a Marketplace plan this year and four million fewer people will be uninsured. Overall, they helped Marketplace enrollment grow from 12 million in 2021 to a record 24.2 million in 2025.

As the Commonwealth Fund notes, the enhanced subsidies have especially benefited low-income people, increasing enrollment among those with incomes below 250% of poverty from 8.2 million in 2021 to 15.9 million in 2024.

Similarly, the Urban Institute predicted they would help the lowest income groups see a 50 to 100% reduction in their premium amounts this year, while people at the higher end of income eligibility would see a 25% reduction. These projections align with documented successes: In 2023 and 2024, 80% of Marketplace enrollees could find a plan for $10 or less per month. In 2020, before the tax credits were increased, only 36% of PTC-eligible enrollees could find such a plan.

Enhanced Credits Critical for Older Adults

A new report from AARP explains how many older adults who are not yet eligible for Medicare rely on Marketplace coverage and premium tax credits, and that the enhanced subsidies have been vital to improving enrollment and coverage among this population. In part, the PTCs have helped millions of adults aged 50 to 64 buy coverage through the Marketplace—spurring a 50% reduction in the uninsured rate among this cohort.

In 2024, nearly five million of the 5.2 million Marketplace enrollees aged 50 to 64 received PTCs. A previous Avalere analysis estimated the credits saved these enrollees at least $600 a year, while some saw savings of nearly $5,000. Heightened affordability is especially important to this population, since ACA premiums for older adults can be up to three times higher than those for younger adults.

What Is At Risk

If the enhancements expire at the end of the year, analysts agree that rising costs will push many people, including older adults, out of their health insurance coverage. KFF projects enrollee premium payments would increase by over 75% on average, while people in rural areas could see a 90% increase and some enrollees could end up paying more than double.

Of the 5.2 million adults ages 50 to 64 with Marketplace coverage, AARP expects most—92%, or 4.8 million of them—will see higher premiums in 2026. Middle-income midlife enrollees could see hikes of over $4,000, likely causing many to drop their coverage and become uninsured.

The Congressional Budget Office (CBO) reached similar conclusions, estimating that unless the credits are extended, ACA enrollment will drop from nearly 23 million in 2025 to 15 million in 2030. Other analysis is even more stark. KFF notes actuaries at Wakely have warned of a 50% decline in Marketplace enrollment, when combined with the other changes to the ACA made in the reconciliation bill.

Some who lose subsidized Marketplace plans may be able to find other insurance, but others—at least 4.2 million people, according to CBO—will become uninsured. These coverage losses will not only mean reduced access to care and worse individual health outcomes, but also higher Medicare costs, because more people will enter the program in poorer health and needing more expensive interventions than they would have otherwise.

Congress Must Act Quickly

At Medicare Rights, we will continue to work to protect the ACA’s coverage gains. People must have access to high-quality, affordable health care and coverage. Allowing the enhanced PTCs to expire would have the opposite effect. It would effectively raise taxes on low- and middle-income Americans, pricing millions out of health coverage.

To that end, we urge lawmakers to extend the enhanced PTCs without delay. Although the credits do not expire until the end of December, their availability must be guaranteed before open enrollment begins on November 1. Otherwise, people may have no choice but to drop coverage this fall in the face of sky-high premiums, setting in motion harmful coverage losses that undermine individual health and economic security as well as Medicare sustainability.

Read the AARP fact sheet, Premium Tax Credits Protect Affordability of Marketplace Health Coverage for Adults Ages 50 to 64.