When the Affordable Care Act (ACA) became law, it opened the door to affordable health coverage for millions of people by providing enhanced Premium Tax Credits (PTCs) to offset a portion of their monthly insurance premiums. But even with this big step forward, many people still found themselves limited by financial barriers for Marketplace plans with a price tag they couldn’t afford. This has been especially profound for people and families in non-expansion states like Georgia, Texas, and Florida where policymakers continue to block efforts to expand Medicaid.

To make health insurance more accessible to millions of families and individuals, in 2021 the Biden-Harris administration and Congress enhanced the Premium Tax Credits through the American Rescue Plan Act (ARPA) and the Inflation Reduction Act (IRA). This made Marketplace insurance more affordable for millions of eligible individuals and families by increasing their tax credit amount and allowing more people to purchase health insurance coverage without going into debt.

Without these enhancements, it is estimated that premium payments would have averaged about $700 more per person per year.

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These tax credits have helped ensure that ACA Marketplace plans cost no more than 8.5 percent of a household’s income – and marked a pivotal moment in the ongoing effort to make health care affordable for all, regardless of income, race, or geography. The impact has been profound, especially for Black and Latinx families and people with low incomes who have historically faced higher barriers to health care access. 

Enhanced Premium Tax Credits (PTCs) are a key feature of the Affordable Care Act, designed to make health insurance more affordable for people with low and middle-incomes. Enhanced PTCs work by reducing monthly premium payments.
Enhanced Premium Tax Credits have made health care more affordable and accessible for millions of people.

Thanks to the enhanced PTCs, we have seen record enrollment numbers in recent years, with over 21.4 million people enrolled in insurance plans through the Marketplace in 2024. These tax credits didn’t just reduce monthly premium payments for millions; for some, they eliminated them entirely.  

21.4 million people enrolled in Marketplace insurance plans thanks to enhanced PTCs

However, these additional financial supports are set to expire in 2025 which could disproportionately impact already vulnerable communities and reverse recent gains in reducing the uninsured rate. 

In fact, a new Congressional Budget Office report paints a stark picture of the future, projecting that by 2034, a staggering 8.9 percent of the U.S. population will find themselves without health coverage. This marks a significant increase from the 7.2 percent uninsured rate in 2023, representing millions of individuals potentially losing access to affordable health care.  

Don’t Let Congress Take Us Backwards. Extend Enhanced Premium Tax Credits Now. 

The good news is Congress can step in to prevent this by extending PTCs and stop millions of people from losing access to affordable health care.  

Without these tax credits, more people would be uninsured and forgo necessary care due to cost or find themselves resorting to predatory deferred interest credit cards to cover basic medical needs — potentially leading to increased medical debt. This debt can have long-lasting financial consequences, affecting credit scores and overall economic stability, especially for those already struggling financially.   

That’s why Community Catalyst, alongside local, state, and national partners, are working hard to shine a brighter light on the benefits of these tax credits; and organizing together to ensure that policymakers extend PTCs again, and eventually make them permanent. 

Resources

How State and Federal Action Can Drive Health Care Affordability

People need a health care system that makes it easy to afford preventive care and visit the doctor when needed. When the Affordable Care Act (ACA) became law, it made comprehensive quality, affordable health coverage available to millions of people. It gave states new authority, tools and an infusion of federal funds to improve health care coverage and access. Updates to the ACA have made coverage even more affordable for so many people and families. The extra help, called enhanced Premium Tax Credits (PTCs), made health coverage affordable for millions of people and enabled states to do even more to make care affordable. Unfortunately, it is set to end unless Congress steps in.   

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Community Catalyst Joins 100+ Multi-Issue Groups to Urge Congress to Center Health Justice Priorities in Overhaul of the U.S. Tax Code in 2025

Community Catalyst joined over 100 national multi-issue organizations representing tens of millions of people from all 50 states and the U.S. territories to call on Congress to pass a bold set of changes to the tax code – including changes that would increase corporate taxes to advance health and economic justice priorities – when several parts of the 2017 Trump tax bill expire next year.

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The Future of Tax Reform: Centering Health Justice Priorities

Far too much of the health care industry puts profits above people, with a large assist from the tax code. The unfettered, profit-driven corporate evolution of health care is behind harmful trends that are raising costs and putting essential care out of reach, especially for people with low-incomes, communities of color, and immigrants. This is seen most clearly when we look at the way many non-profit hospitals contribute to the medical debt crisis, as well as the rise of private equity in health care.

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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. 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. 

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