Notice that this article doesn’t talk about people who are on Medicare and/or Medicare disability. The average retired couple gets ~ 37,000.00/yr in social security. I went back and looked at what we paid for Medicare Part B & Part B supplement and since 2020. The premiums have only increased $5,300/yr. THREE to FOUR times what they are talking about the AVERAGE FAMILY will have their premiums increased, without tax credits. Keep in mind that nearly 50% of families don’t pay any federal taxes.
The youngest Baby Boomer will not turn 65 y/o and be eligible for Medicare until 2029. Is it just me or does it seem that once you are unfortunately disabled or retired…. you are pretty much on your own to survive. Of course, if you can’t get proper medical care, you will fall off the list of getting back all the money you paid into the SS system?
The cost of inaction is high
https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/117991
In the U.S., no politically driven healthcare crisis ever really ends. It just mutates.
Case in point: the current debate over extending enhanced Affordable Care Act (ACA) health insurance tax credits, which will expire at the end of 2025 if Congress does not act. Most (but not all ) Republicans want to end
these subsidies, while most Democrats want to keep them. This is a primary factor in why the federal government shut down on October 1.
If the GOP gets its way, ACA health insurance coverage for tens of millions of Americans will become more expensive. For households earning between $28,000 and $55,000 per year, their annual premiums would rise by anywhere from $1,200 to $1,800
A Brief History of ACA Premium Support
Originally, ACA premium tax credits were designed to help low- and middle-income Americans afford insurance through the ACA marketplace. People earning between 100% and 400%
of the federal poverty level (FPL) would pay no more than a set percentage of their income toward premiums. The federal government would cover the rest.
Then came the COVID-19 pandemic. To prevent a coverage collapse, Congress approved and President Joe Biden signed into law the American Rescue Plan Act
in 2021, which temporarily boosted those credits and eliminated the upper income cap. Suddenly, more Americans, especially self-employed individuals, gig workers, and middle-income families, could afford coverage.
The Inflation Reduction Act (IRA) of 2022 extended enhanced credits through 2025.
Enrollment exploded to record highs: according to the Kaiser Family Foundation (KFF), after the introduction of the enhanced premium tax credits, the number of people enrolled in the ACA marketplace more than doubled from about 11 million people to more than 24.3 million this year
Unless Congress acts before December 31, the enhanced credits will disappear. At that point, only Americans from households with incomes between 100% and 400% of the FPL will generally qualify
for ACA premium tax credits.
Policy Whiplash Harms Care
For 15 years, the ACA has been a political football. You may recall that this current stalemate is not the first time
Congress shut down the federal government over ACA policy. And during Trump’s first term, the administration dramatically cut the federal role in administering the ACA. The Biden administration reversed many of those policies and enhanced tax credits. Ironically, more than 80%
of people who now benefit from the enhanced tax credits live in states won by Trump in 2024.
Now, as the political pendulum swings back, Americans are once again left wondering: Will I still be able to afford insurance next year?
That kind of uncertainty erodes faith in government, and in healthcare itself. It is difficult to plan for preventive care or manage chronic conditions when your ability to afford coverage depends on who wins the next election.
Unfortunately, we’re already getting a taste of the likely consequences: as ACA plans post rates for 2026 that account for the potential loss of enhanced subsidies, some Americans may assume they can’t afford health insurance and not sign up
.The Financial Shock Ahead
According to the Peterson Foundation, more than 300 ACA marketplace insurers submit rate filings with regulators from each state every year. While ACA marketplace premiums have increased over the past several years, 2026 is expected to be the biggest increase in premiums since 2018 — even if the tax credits remain in place. (In 2025, premiums increased a median rate of 7%
.) Take those subsidies away, and the financial burden will be catastrophic for those who depend on the ACA for insurance.
Failure to extend the enhanced credits combined with planned insurance premium hikes could lead to ACA marketplace premium increases of more than double
! Self-employed adults, small-business owners, and small-business employees (nearly half
of those on the ACA) — the very people least likely to have employer-based coverage — will be hit hardest with higher rates.
And then there are the Americans who will lose coverage.
The Urban Institute estimates that without enhanced credits, the number of uninsured people will increase by about 4.8 million
. In contrast, if Congress permanently extends the tax credits, an additional 3.6 million people
would have health insurance by 2030.
The Domino Effect
Every American with ACA marketplace coverage will feel the pain if Congress does not act.
When individuals drop coverage, consequences ripple across the system. Hospitals see spikes in uncompensated care. Clinics treat more patients who delay preventive visits until conditions worsen, raising overall healthcare spending (and, of course, leading to worse health outcomes). Insurers raise premiums for everyone else to offset losses. The uninsured get sicker, and the insured pay more.
For Americans and their healthcare providers, this scenario could not be unfolding at a worse time. States are still untangling the chaos from Medicaid redeterminations, which have already pushed 27 million people
off Medicaid rolls since 2023. Many of those individuals were supposed to transition to ACA coverage. Now, just after they have lost Medicaid, they could lose affordable marketplace options too.
Inflation, labor shortages, and rising hospital costs only magnify the pressure. If ACA enhanced credits lapse, the entire healthcare ecosystem will suffer. The uninsured rate, which fell to a record low of 7.2%
in 2023, will climb again. Rural hospitals, which are already closing at alarming rates, will face more uncompensated care and risk bankruptcy. Small businesses and gig workers will face impossible choices between paying premiums or paying rent.
The pain will not be evenly distributed. The largest coverage losses will occur in non-Medicaid-expansion states , mostly in the south and Midwest. These regions are the ones suffering from highest rates of hospital closures, physician shortages, and poor healthcare system performance
. The result is a deeper divide between the insured and the uninsured, and an even more fractured healthcare system.
Fixing healthcare in America does not require a massive overhaul or new bureaucracy. It requires predictability. Congress should make the enhanced premium tax credits permanent and provide long-term stability for the ACA marketplaces. That one move would stabilize insurance markets, reduce churn, and give patients, providers, and insurers the certainty they need to plan for the future.
The ACA has never been perfect. But when funded, supported, and left to function without constant sabotage, it works. Republicans must accept that fact.
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