Marketplace Enrollees Tell Congress: Extend the Enhanced Premium Tax Credits

No one should be forced to choose between taking care of their health or paying for other basic needs, like food or utilities. But if enhancements to the premium tax credits (PTCs) expire at the end of this year, that will be the case for millions of people who buy their insurance through the Affordable Care Act (ACA) marketplaces.

The enhanced PTCs have made marketplace coverage more affordable, resulting in a record number of people gaining insurance through the marketplace. Growth has been concentrated among Black and Latino people, people with low incomes, and people living in states that haven’t expanded Medicaid. The marketplace is also an important source of coverage for small businesses and self-employed individuals.

But unless Congress acts, the enhanced PTCs will expire at the end of 2025, causing premiums to spike for both subsidized and unsubsidized enrollees. As a result, an estimated 4.2 million people are expected to drop their marketplace coverage and become uninsured in 2034.

“Dropping the enhancement now is going to put the hurt on a lot of people who aren't going to be able to absorb those costs since everything else is going up,” said Carrie, a 49-year-old Iowan who is the primary caretaker for her mother and gets her insurance through the marketplace. “This is something that is a pretty easy way to continue helping the American people who need it.”

Already, insurer rate filings for 2026 are showing double-digit rate increases in marketplace premiums. These rate increases reflect federal policy changes, like the impending expiration of the enhanced PTCs and a new Trump Administration rule that makes it harder for people to get and keep their marketplace coverage. Insurers expect that these changes will lead people with fewer health needs to drop their marketplace coverage, meaning the marketplace risk pool will have more people with greater health needs, who are more expensive to insure.

Extending the enhanced PTCs would reduce the premiums most people pay, greatly reducing premium shocks. But Congress must act soon, as enrollees will start getting their renewal notices — which include information about the next year’s premiums — in late summer and early fall.

“Sacrificing Essentials”

In March, April, and May 2025, CBPP convened 21 marketplace enrollees across ten states for a series of focus groups to better understand how the imminent expiration of the enhanced PTCs would impact their lives. Most participants were surprised and alarmed to learn that the premium tax credit would drop substantially at the end of 2025 if Congress does not act, dramatically increasing their costs for coverage in 2026.

As part of the focus groups, enrollees were asked to use a KFF calculator to determine how much their premiums would increase if the enhanced PTCs aren’t extended. Many enrollees said that higher premiums, combined with increasing costs in other areas of their household budgets, would strain their finances and force them to either drop their health insurance or compromise on other basic needs.

“If my marketplace plan were to increase by $103 a month, I honestly don't know what I would do,” said Tracy W., a 57-year-old customer service representative from Georgia. “That amount may not seem like much to the government or to the insurance companies, but for me it would most likely mean sacrificing essentials: groceries, gas, basic necessities that I rely on.”

Some enrollees said that losing the enhanced PTC would force them to drop their coverage, even though they fear for their health. “The increased cost wouldn't be affordable for me right now,” said B.A.P., 35, a restaurant manager from North Carolina. “I would consider dropping insurance if the cost goes up too much. I would avoid medical attention until it's an emergency. And I also think there may be a greater risk of complications from illnesses because they weren't prevented.”i If the enhanced PTCs expire, B.A.P.’s premiums are estimated to increase by 185 percent in 2026, from $25 to $135 a month.

Hear more from Tracy and B.A.P.:

“Maybe I Have to Hold Back … Eat Less … Take Less Insulin”

But for some people, especially those with chronic illnesses, going uninsured is not an option. If the enhanced PTCs expire, M.M., a 45-year-old IT consultant from Illinois with Type 1 diabetes, said he “would just have to make sacrifices in other aspects of my life so I could afford the increased cost of that insurance.” His premiums are estimated to increase by $95 a month in 2026 if the enhanced PTCs end, which he says would cause him to ration care.

“I would have to consider switching to a cheaper plan which has a higher deductible, which means that at the beginning of the year I'd have to pay for my medications out of pocket,” he said. “And maybe I have to hold back on some of those medications, eat less, so take less insulin to treat my diabetes.”

Hear more from M.M.:

Workers who are self-employed as freelancers, gig workers, part-time workers, or a combination of these, don’t have employer-sponsored insurance. The enhanced PTCs have been a lifeline so these workers can affordable health insurance.

“It’s impactful for many people who might also be invisible like I am as a freelancer,” said Kat M., a 64-year-old in California who faces a possible $70 per month premium increase. “Here we are trying to make a living any way we can. There are a lot of us who don't have the access that others have with group insurance through their work.”

Hear more from Kat M.:

Overwhelmingly, the marketplace enrollees we spoke with want Congress to extend the enhanced PTCs. “This is a program that is used by millions of people around the country,” said M.M., the IT consultant from Illinois. “The subsidies and the enhanced subsidies really make life easier. And I think it would greatly benefit [people] if they were extended indefinitely.”