Dec. 20, 2024 (ACP) -- With Affordable Care Act (ACA) marketplace plan premium tax credits slated to expire at the beginning of 2026, the American College of Physicians is urging Congress to permanently extend the tax credits and is advocating for other changes that will protect patients and help them choose the right plan.
ACP is concerned that expanded marketplace premium tax credits will expire as of Jan. 1, 2026, unless Congress and the president take action to extend them.
“A record high number of people enrolled in the Affordable Care Act marketplace plans in 2024 due in part to the enhanced premium tax credits that made coverage more affordable,” said Ryan Crowley, ACP manager for health policy. “If they aren't permanently extended, the Congressional Budget Office estimates that premiums will increase, and the number of uninsured will increase by an average of 3.8 million each year over the 2026 to 2034 period.”
According to a report by the Center on Budget and Policy Priorities, “93 percent of marketplace enrollees, or 19.3 million people, receive premium tax credits.”
The enhancements amount to an average of $705 a year in savings per enrollee, the report says, and they allow people with incomes between 100 and 150 percent of the poverty level to pay nothing for silver-level plans.
The premium enhancements “have been especially critical for increasing enrollment among Black and Latino people,” the report says. “People of color made up 54 percent of marketplace enrollees in 2024, up from 46 percent in 2021. Between 2021 and 2024, marketplace enrollment among Black and Latino people grew by 186 percent and 158 percent, respectively, compared to 63 percent for other racial and ethnic groups.”
KFF has provided a calculator to see how much premiums might rise in an area if the premium tax credits are not renewed.
For the tax credits to be renewed, Congress will need to pass a temporary or permanent extension, and the president will have to sign it into law.
“The political situation is in flux, but the Republicans rejected a deal to extend the credits by one year. They argue it's too expensive,” Crowley said. “However, a big chunk of the funding goes to patients in Republican-leaning states that haven't expanded Medicaid like Florida and Texas, so lawmakers in those states may see some pushback from constituents if they don't support an extension.”
ACP wants the enhanced premium tax credits to be made permanently available to patients who are eligible for them. To achieve that goal, ACP supports the Health Care Affordability Act. ACP is also part of a coalition called Keep Americans Covered that is pushing for a permanent extension.
On a related front, ACP sent a Nov. 12 letter to Xavier Becerra, secretary of the U.S. Department of Health and Human Services, that offered ACP's perspective on proposed ACA patient protections for 2026.
“ACP called for HHS to prevent fraudulent plan switching by brokers and agents,” Crowley said. As the letter noted, “ACP supports interventions to prevent the use of fraudulent, deceptive and high-pressure sales tactics to enroll patients in health insurance plans and to penalize those individuals and organizations which promote such activity.”
ACP also supports changes to make shopping for the right plan less confusing. “Standardized plans, particularly those that incorporate value-based insurance design concepts, may be a way to encourage high-value care and make the health insurance shopping experience more patient-friendly,” the letter states. “ACP supports the proposal to require standardized plans to be meaningfully different to prevent choice paralysis and make it easier for patients to find a plan that meets their financial and health care needs.”
In addition, Crowley said, “ACP expressed support for a practice called silver loading, which makes premiums more affordable for certain patients.”
Back to the December 20, 2024 issue of ACP Advocate