The expiration of Affordable Care Act tax credits will leave nearly four million people without coverage. Rising premiums threaten to deepen the nation’s health and economic crisis.
The social health crisis in the United States seems like a story with no end. The expiration of the Affordable Care Act (ACA) premium tax credits threatens to leave millions without coverage — just as the federal government shutdown enters its tenth day.
This month, millions of Americans will face an unpleasant surprise as they discover that their monthly premiums have nearly doubled. With enhanced tax credits set to expire at the end of the year, around four million people will immediately lose their health insurance.
In a briefing “As Shutdown Drags On, Is a Compromise Over Health Care Costs Possible?”, held by American Community Media, health experts and policy leaders discussed the crisis and possible solutions to yet another challenge testing the stability of the U.S. health system.
Rising Premiums and Political Choices
Anthony Wright, Executive Director of Families USA, warned that “between 22 and 24 million people will see their premiums increase, and around four million will lose their health insurance immediately.” He emphasized that the elimination of tax credits represents “a political decision, not an economic necessity,” since both Congress and the current administration “chose to extend benefits to corporations while rejecting measures to protect low- and middle-income citizens.”
Wright explained that premiums will rise by an average of 18%, but the real impact on consumers — without subsidies — will amount to “a doubling or even tripling of monthly costs.” He gave a concrete example: “In Maine, a 60-year-old earning $65,000 will see their monthly payment jump from $460 to $1,400.”
He also warned that the end of tax credits will disproportionately affect rural communities, where medical costs are higher and local hospitals rely heavily on insured patients. “Fewer insured patients mean more uncompensated care and an increased risk of closure for rural clinics and hospitals,” Wright said.
Losing $0 Premiums and the Impact on Vulnerable Groups
Jennifer Sullivan, Director of Health Coverage Access and lead for the Beyond the Basics project at the Center for Budget and Policy Priorities (CBPP), discussed the consequences of eliminating $0-premium plans for low-income populations in the U.S.
Sullivan noted that “93% of people enrolled in the marketplace receive tax credits to reduce the cost of their insurance,” a figure that reveals just how dependent millions of households are on these subsidies. She added that “90% of enrollees have incomes below four times the federal poverty level, and nearly half live on less than twice that threshold — about $32,000 a year.”
According to Sullivan, the end of $0 premiums will hit hardest among self-employed workers, small business owners, young adults just out of college, and people over 55 who don’t yet qualify for Medicare. She also warned that “more than half of marketplace enrollees are people of color,” meaning the loss of subsidies would undo progress made since 2021: “We saw a 186% increase in coverage among Black Americans and a 158% increase among Latinos. Losing those gains would be devastating.”
Sullivan also addressed the situation of immigrants, reminding the audience that undocumented people “deserve health coverage but remain excluded from the system,” while recent policy changes have further limited access for those legally residing in the country. “The biggest risk now is the fear effect — people who are eligible but afraid to sign up,” she said.
On $0-premium plans, she was emphatic: “If someone can’t pay even a single dollar, it’s not a lack of commitment — it’s survival. Eliminating $0 premiums would leave around 400,000 people uninsured.” She stressed that this benefit has been crucial, especially in states that didn’t expand Medicaid, where marketplace coverage is the only option for those earning between 100% and 138% of the poverty level.
Sullivan called the situation “urgent and avoidable,” adding that “insurers are already posting 2025 prices in six states, and the increases are so steep that many will drop out before December.”
Public Awareness and Bipartisan Support
The final presentation came from Dr. Ashley Kirzinger, Associate Director of the Public Opinion and Survey Research Program at KFF, who shared findings from a national survey on public perception of rising health care costs and the looming expiration of ACA tax credits.
Kirzinger warned that the cost of medical services and unexpected bills now rank as the top financial concern among American families — even above housing, utilities, and food. “Nearly half of adults say it’s difficult to afford medical care, and one in four has struggled to pay for it in the past year — even with tax credits still in place,” she said.
The researcher also highlighted the public’s limited awareness of the issue: “Only four in ten people have heard anything about the expiration of the credits, and six in ten — including those who buy coverage through the ACA marketplace — don’t know they’re about to lose that benefit.” This means millions will face price hikes without warning, just as open enrollment begins.
Still, Kirzinger underscored a striking finding: broad bipartisan support for extending the tax credits. “Eight in ten Americans want Congress to keep them — 92% of Democrats, 82% of independents, and 59% of Republicans, including 57% of MAGA supporters,” she noted. “They may not like Obamacare,” she added wryly, “but what they hate more are high health care costs.”