Why Enhanced Premium Tax Credits Should Be Made Permanent
Last Updated on October 9, 2025
Enhanced tax credits help make health insurance more affordable for individuals and families buying plans through the Affordable Care Act (ACA) marketplaces, including self-employed and gig workers. Created through the American Rescue Plan Act (ARPA) and extended through the Inflation Reduction Act (IRA), they significantly combat high health care costs and increase families’ access to affordability assistance. Since their implementation, the enhanced tax credits have helped reduce the uninsured rates, especially among Black and Latino individuals and lower income families, leading to record marketplace enrollment numbers.
Unfortunately, they expire at the end of 2025 unless Congress takes immediate action to help families avoid high health care costs by voting to make the enhanced tax credits permanent. If they don’t, premiums will increase for nearly all marketplace enrollees, and millions of people could lose their health insurance — reversing the health coverage gains over the last few years.
Families USA is a leading health care advocacy organization urging Congress to make them permanent. This fact sheet offers resources from Families USA and other organizations to help advocates and others interested in ensuring that millions don’t lose coverage and face high health care costs and premiums because Congress fails to act.
To learn more, view the national and state-specific fact sheets about premium tax credit enhancements in ACA marketplaces.
- State-by-state maps of people losing coverage by income level, age, race and ethnicity.
Source: Urban Institute (11/24) - Navigators and enrollees in various states talk about the importance of extension.
Source: CBPP (7/25) - An estimated 90% of workers whose occupations do not offer health insurance use the ACA
Marketplace, and 93% of this group relies on Premium Tax Credits to afford health care. This
brief breaks down the percentage of workers by occupation that relies on individual market
coverage.
Source: KFF (9/25)
- More than 70 organizations call on Congress to extend enhanced premium tax credits to keep health care affordable for millions of Americans.
Source: Families USA (12/24) - The National Association of Insurance Commissioners (NAIC) supports extending enhanced premium tax credits, and urges a decision by the end of 2024.
Source: NAIC (7/24) - Marketplace Enrollees Speak Out: People Fear Higher Costs if Congress Does Not Act
Source: CBPP (9/24) - 2.7 million small businesses and self-employed workers claimed the tax credit in 2022.
Source: US Treasury Department (9/24) - How Enhanced Premium Tax Credits for Affordable Health Care Empower Self-Employed Americans.
Source: Center for American Progress (10/24) - Understanding how the enhanced premium tax credits impact consumers.
Source: State Marketplace Network
- State and congressional district data about the number of people who receive tax credits and the average annual premium increases they’d experience if enhancements expire.
Source: Keep Americans Covered - Review the “health care savings” of this review of Congressional Districts.
Source: Regional Leadership Council - This interactive “2024 Affordable Care Act Marketplace Plan Selections by Congressional District” includes data for the federally facilitated marketplace, Washington, DC, and Vermont.
Source: Center for American Progress (5/24)
- Robert Wood Johnson Foundation (RWJF) finds that in the leading farm states, a significant share of residents enroll in Medicaid and in the marketplace. In farm states, about half of marketplace enrollees are rural residents. Premium tax credits reduced marketplace enrollees’ premiums by an average of $506/month in farm states.
Source: RWJF (5/24)
- More people would become uninsured and seek uncompensated care. Hospitals and providers would take a hit, particularly in the South, rural communities, and in states that have not expanded Medicaid.
Source: Urban Institute (12/24) - 7.3 million Americans will lose subsidized Marketplace coverage, and 4.8 million people will
become uninsured in 2026 if the Enhanced Premium Tax Credits are not extended.
Source: Urban Institute (9/25)
- Data by age, income, and for Blacks and Latinos.
Source: Center for Budget and Policy Priorities (CBPP) (11/24) - Enhanced premium tax credits cut premium payments by 44% on average and helped more low-income enrollees enroll in plans with reduced deductibles. Premiums would double in 12 states for subsidized enrollees if enhanced premiums expire.
Source: KFF (7/25) - Find out how much ACA premium costs could increase in your state or congressional district using this interactive map.
Source: KFF (2/25) - State-by-state fact sheets on marketplace enrollment, premium tax credits, and increased costs if enhanced credits expire.
Source: Commonwealth Fund (8/25) - The expiration of the Enhances Premium Tax Credits could lead to an increase of $7.7 billion in
uncompensated care. Healthcare providers are projected to lose $32.1 billion in revenue in
2026 should this happen. See the brief for other changes in spending broken down by state.
Source: Urban Institute (9/25) - This data shows the “double whammy” faced by patients of losing tax credits and paying more
for premiums.
Source: KFF (9/25)
- 5.1 million ages 55–64 enrolled in Marketplace coverage in 2024 and more will do so as Medicaid unwinding continues. Uninsured rates for older adults have dropped dramatically since Affordable Care Act (ACA) implementation.
Source: AARP (5/24) - Without enhanced premium tax credits, a 60-year-old earning $60,251 would pay almost 20% of his or her income for an average marketplace plan.
Source: Urban Institute (9/24) - If enhanced credits expire, many 50-year-olds will see their silver plan premiums increase by 53%, and in some places, they will increase by 75%.
Source: RWJF
Map by zip code - Nearly 5 million midlife adults will face higher premiums if enhanced tax credits expire. For middle income midlife enrollees, average annual premium increases will be more than $4,000.
Source: AARP (4/25) - An estimated 41% of people enrolled in Marketplace health care are between the ages of 45 –
64, and 92% of these people are expected to experience increases in the cost of coverage if the
Enhanced Premium Tax Credits expire.
Source: AARP (9/25)
- In states using healthcare.gov, consumers with enhanced premium tax credits are saving an average of 48% on monthly premiums, due to the availability of expanded subsidies.
Source: Centers for Medicare & Medicaid Services (CMS) - Enhanced premium tax credits fueled marketplace enrollment growth.
Source: KFF (4/25) - This calculator breaks down the cost of Marketplace insurance with and without Enhanced
Premium Tax Credits by state, county, income, and family size.
Source: KFF (9/25) - See how State-based Marketplaces are affected by the Enhanced Premium Tax Credits and
resources related to enrollment in 2026.
Source: State Marketplace Network (9/25) - This article highlights challenges low- and moderate-income families would face if the Premium
Tax Credits are not renewed.
Source: CBPP (9/25) - Some low- and moderate-income families would have to pay as much as one-third of their
annual income on health care without the use of Premium Tax Credits.
Source: KFF (9/25)
- Ending enhanced tax credits will cost state jobs and harm state economies: health insurers will cut payments to providers, who will in turn cut jobs or close; individuals and families will lose income; employment will decline; and states will lose tax revenue.
Source: Commonwealth Fund (3/25) - An estimated 30% of all Marketplace health care enrollees are entrepreneurs and small business
owners. This resource contains the views of small business owners and how they see Enhanced
Premium Tax Credits affecting their local economies.
Source: Small Business Majority (8/25)