CBO report is a call to action for Congress 

An explosive new Congressional Budget Office report, released last week, should be a call to action for Congress to act and protect health care access for millions of people. 

The report, which received very little press attention, found that the rate of people without health insurance will rise over the next decade after reaching a historic low last year. And that by 2034, 8.9 percent of the U.S. population won’t have health coverage, up from 7.2 percent in 2023.  

The good news is Congress can step in to prevent this by extending enhanced Advanced Premium Tax Credits (APTCs) and stop millions of people from losing access to affordable health care.  

In 2021, in an effort to stabilize health insurance coverage, the Biden administration and Congress enhanced Advanced Premium Tax Credits as part of the American Rescue Plan Act. These tax credits helped make health insurance more accessible to more people under the Affordable Care Act—significantly increasing the enrollment of individuals and families with low-and middle- incomes, many of whom have been able to purchase health insurance through the ACA Marketplaces for the first time.  

Enhancing these tax credits reduced premiums to zero for some people with low incomes, and made tax credits more widely available to people with middle incomes. In 2022, recognizing the significant health and economic benefits to people and communities, the Biden administration and Democrats in Congress once again stepped in to extend the program through 2025 as part of the Inflation Reduction Act. As a result, Marketplace enrollment steadily increased and, during the 2024 open enrollment period, jumped by 5 million people, or 31 percent. 

These health care tax credits have been a huge success and a key ingredient in achieving record low uninsurance rates in the country. According to a recent report from the Urban Institute, 7.2 million more people will receive subsidized Marketplace coverage in 2025 than if Congress had not extended the enhanced APTCs. And it will have its largest impact in states that often have higher uninsured people like Texas, South Carolina, Mississippi, Louisiana and Georgia.  

The CBO report assumes that the tax credits will expire, leading it to the projection of higher uninsurance rates. Yet we know that these tax credits are a proven way to expand access to coverage and care—particularly among Black, Hispanic and AAPI communities—and reduce individuals’ health care costs. They are a vital lifeline for millions of people, and if Congress fails to act—and extend these tax credits—that lifeline will be pulled away.    

And let’s be clear: Extending APTCs is not just a matter of economic relief for millions of people; it is a matter of public health. Access to affordable health care coverage leads to better health outcomes, reduced mortality rates and decreased reliance on emergency room care. When individuals can afford to see a doctor regularly and manage chronic conditions, they are less likely to require costly emergency interventions down the line.  

And importantly, APTCs play a crucial role in addressing health disparities and ensuring that people that have historically faced the highest barriers to care due to racism, classism and other forms of oppression, have the necessary resources to maintain and improve their health. They are critical for many individuals who would otherwise struggle to afford health care, thereby fostering a more equitable and healthier society for all. 

In recent polling, about half of adults say they have difficulty affording health care. And we see disparities clearly in the 60 percent of Black adults and 65 percent of Hispanic adults who report difficulty affording health care costs compared to 39 percent of white adults. But it doesn’t have to be this way.  

Extending these tax credits is essential to making health care coverage more affordable and equitable for families with low- and middle-incomes. The current structure has provided crucial financial assistance to millions and lessened the pressure on people to choose between paying for health care and other basic necessities. And Congress letting it expire would have devastating impacts.  

APTCs are not a cure-all to the reality that many people still face high premiums and out-of-pocket costs that impede access to care. We need to think bigger in order to make health care truly affordable—from reforms that overhaul how we pay for health care, to eliminating unjust and predatory medical debt collection practices, to—ultimately—a system that ensures everyone can access affordable care, regardless of their insurance status. 

And a key part of the journey down that road starts with extending the APTCs. In doing so, Congress has the power to make the CBO report just a projection, not a reality. They should act without delay.

Mona Shah is Senior Director of Policy and Strategy at Community Catalyst.