FIGHTING ON TWO FRONTS: PROTECTING THE ACA PREMIUM TAX CREDITS AND PURSUING UNIVERSAL HEALTH CARE

As 2025 rolls to a conclusion, an increasing number of people are justifiably freaking out whether they’ll be able to access basic health care. They’re worried about, for instance, whether they’ll be able to come up with the cash to pay for their meds. They’re worried about possibly having to “stretch out” their insulin, making it last longer by occasionally skipping a dosage or, perhaps, taking their doctor’s recommended dosages but taking less than the recommended amounts. They’re worried about what will happen to them if they experience a major illness.

They’re worried, in short, about their health care cost increasing; about not being able to afford their meds; about not having access to health care when needed; about losing or not having health care insurance [Click here to see the results of a poll recently conducted by AP-NORC on health care worries].

Such worries, undoubtedly, have been simmering for more than a minute. But they are especially poignant at this moment because there’s a real possibility that, in a matter of months, the ranks of the uninsured will swell by the millions.

THE POTENTIAL DEMISE OF ENHANCED PREMIUM TAX CREDITS, THE RISE IN INSURANCE PREMIUMS, AND THE RISE IN THE NUMBER OF PEOPLE LACKING HEALTH INSURANCE

First off, what in the world are Premium Tax Credits (PTCs) and what do they have to do with health insurance? Here’s how the Internal Revenue Service answers these questions:

The premium tax credit – also known as PTC – is a refundable credit that helps eligible individuals and families cover the premiums for their health insurance purchased through the Health Insurance Marketplace.

Essentially, then, PTCs are subsidies paid to insurers who, in turn, offer eligible persons lower cost policies through the government’s Health Insurance Marketplace.

PTCs are central to the Affordable Care Act (ACA) since its inception in March 2010. A decade later, the nation found itself in the grip of the COVID-19 pandemic and a resulting economic slump. In response, and as part pf the American Rescue Plan Act of 2020, Congress “enhanced” or increased the size of the PTCs, as well as expanded the number of people eligible to access health care coverage through the government marketplace.

In 2022, Congress extended the “enhanced” PTCs through 2025 as part of the Inflation Reduction Act. It’s the “enhanced” or more “generous” tax credits that’ll expire at the end of the year unless Congress acts to extend or make them permanent. If Congress fails to act, then any remaining PTCs will be the “non-enhanced” or “standard” ones that existed prior to the enactment of the American Rescue Plan Act (ARPA).

Still, the evidence clearly indicates that rolling back the “enhanced” PTCs will unleash some serious hurt. And just in case you don’t think so, consider the finding of a recent study undertaken by the Urban Institute and the Commonwealth Fund. These researchers find that:

• Allowing the “enhanced” PTCs to expire will lead to 7.3 million fewer persons receiving subsidized marketplace coverage in 2026

• Allowing the “enhanced” PTCs to expire will increase the number of persons without any health insurance by almost 5 million (4.8 mil, to be exact).

• Allowing the “enhanced” PTCs to expire will result in substantially higher net premiums (what you have to come out of pocket after the “standard” or “non-enhanced” subsidies are taken into account) for marketplace participants:

  • Average net premiums will quadruple for those marketplace participants with incomes below 250% of the federal poverty level (FPL), rising from an average of $169 to $919 in 2026.

  • Average net premiums will double for those whose incomes fall between 250% and 400% of the FPL

  • Average net premiums for those with incomes above 400% of the FPL will “nearly double”: This group currently pays, on average, $4,436; in 2026, they would have to pay the full premium out of their own pockets, which would amount to an average of $8,471.

What’s more, the evidence indicates, unsurprisingly, that increases in the number of uninsured will not be distributed across all groups equally. For instance, if the enhanced PTCs are allowed to expire, the data indicates that:

• The number of uninsured Black people will jump 30%, climbing from 3,115,000 to 4,040.000.

• The number of uninsured whites will increase by 25%, jumping from 8,914,000 to 11,175,00

• The number of uninsured Hispanics/Latinos will rise from 8,839,000 to10,130,000, a 15% increase.

If the enhanced PTCs are allowed to expire, just about every group will be staring at double digit increases in the percentage of “members” out here without any health insurance coverage. with Black folk getting hit especially hard [click here for a brief article on how the increase in the uninsured falls differently across different groups].

FIGHTING ON TWO FRONTS

While it’s difficult to exactly pin down a precise estimate, there’s no doubt that rising uninsurance rates contribute to concomitant jumps in the rise of preventable deaths. Hiding behind all these stats are people, not stick figures.

Indeed, public health researchers at Yale and the University of Pennsylvania estimate that the failure to extend the enhanced premium tax credits could result in 8,900 more deaths each year.

So, we need to wage the fight on two fronts. We need to do all that we can to foil every attempt to roll back the enhanced premium tax credits. The evisceration of these subsidies will result in higher premiums, greater numbers of people lacking health insurance, and a rise in the number of preventable deaths.

What’s more, and as pointed out above, the resulting increase in uninsurance will fall especially heavily on Black folk.

We need to fight on this front— that is, the front where we seek to link up with and support all those who seek to extend the enhanced premium tax credits.

This whole fight, though, also underscores why certain “goods” ought not to be treated as commodities that are bought and sold in a market. Some goods, in other words, are so central to human flourishing that they are, in fact, rights—something due to humans qua human. A decent society, a society that respects, protects, and promotes human dignity does the utmost ensure that all have access to these basic rights.

A decent society, in short, treats health care as a right. We desperately need universal health care. We desperately need a health care system that’s not littered with talk about standard premiums, enhanced premiums, deductibles, co-pays, coverage gaps, and subsidy cliffs.

So, yeah, let’s do what we can to defeat the Republican’s attempt to roll back “enhanced” premium tax credits. But let’s be clear: The ACA is severely flawed and no substitute for universal health care—a good not dependent upon being provided by the market but a right due to humans qua human.

That’s the second front.