Have you noticed that the cost of health care is always in the news? I don’t think someone could go for a week reading the paper without seeing an article about Medicare, Medicaid or insurance premiums. Remember all the media attention regarding the One Big Beautiful Bill and cuts to Medicaid? Well, as people are settling back into the swing of things after summer, health care has started to be featured in the news again; this time about the Affordable Care Act’s (ACA) enhanced premium tax credits (EPTC) expiring. Look no further than the ongoing negotiations over government funding in Congress.

The ACA is health care legislation passed by Congress in 2010 that protects people with preexisting conditions, caps older adults’ premiums compared to their younger counterparts, prevents lifetime or annual limits on coverage, and provides essential health benefits and access to preventive services. Originally, the ACA included tax credits to help qualifying people afford insurance in the marketplace. Then in 2021, Congress passed the American Rescue Plan Act, which temporarily created Enhanced Premium Tax Credits (EPTC) and expanded the number of people who qualified. The following year, Congress extended the tax credit expansion through 2025. If the increased tax credits expire, the credits would go back to pre-2021 levels.

According to a 2024 AARP article entitled “Expiring Tax Credits Threaten Affordable Health Coverage for Midlife Adults,” Avalere Health found that about five million people ages 50 to 64 benefited from EPTC. Avalere also reported that EPTC saved this age cohort between $599 and $4,574 on insurance premiums each year. Nationally, this helped the ACA reach its highest enrollment of more than 24 million people and contributed to the uninsured rate falling to its lowest level ever.

Obviously, this begs the question: what if Congress doesn’t extend the EPTC?

Unfortunately, people who receive their insurance through the ACA marketplace can expect to see potential premium increases. In April, AARP reported that if the credits expire, people ages 50 to 64 will see an average increase of more than $4,000 in 2026. The Congressional Budget Office (CBO) projects that the expiration of the tax credits will increase the number of uninsured people by 4.2 million over the next decade. The rising premiums are in part because insurance companies are concerned that if insurance becomes less affordable, healthier and younger people may drop coverage, raising costs for everyone else.

Sadly, the problem doesn’t stop there. Older adults with insurance generally have healthier outcomes.  If people start forgoing health care, it could drive up costs for hospitals for when people seek emergency medical treatment. It could also mean less healthy older adults entering Medicare. Seniors who had health insurance before becoming Medicare-eligible are generally healthier than those who did not.

Politico reported that in Florida, there is concern about small business workers losing the EPTC, as letting the tax credits lapse could shrink the state’s budget as people may choose to go without health care or enroll in Medicaid if they qualify. Brewster Bevis, president and CEO of the Associated Industries of Florida, said, “They’re going to pay it out of pocket, or they’re going to go to the hospital systems for their primary care, which is going to increase costs on hospitals, increase costs from Florida taxpayers on uncompensated care, or go onto the Medicaid rolls. It’s just a real no-win situation.”

Earlier this month, bipartisan legislation was introduced in the House of Representatives to extend the tax credits through next year. However, it should be noted that Rep. Jen Kiggans (R-VA), lead sponsor on the bill, sees this legislation as a temporary solution to the problem and would like to see the credits phased out over time.

It looks like the more things change, the more they stay the same. Fighting over the ACA is sure to continue in Congress as lawmakers debate whether to extend EPTC. The ACA has provided healthier outcomes for older adults on many levels, and discontinuing the credits could be devastating for older adults around the country who have come to rely on more affordable coverage. Hopefully through negotiations these care savings will be extended so that older adults can continue to rely on more economical health care.

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. Click here to read more from Evan Carmen.