“For millions of families, a spike in health care costs might be around the corner because crucial subsidies are set to expire at the end of next year. Some families will see their premiums rise by thousands of dollars; others might lose their insurance altogether.
In 2021, President Joe Biden signed into law the American Rescue Plan Act, which included a provision that enhanced the premium tax credit — a piece of the Affordable Care Act (ACA) that subsidized the cost of premiums for some lower- and middle-income families. The Biden-era enhancements, which essentially expanded the number of people who qualify for the tax credit, were originally set to expire at the end of 2022, but Congress extended them through 2025 when it passed the Inflation Reduction Act. (For families at or slightly above the poverty line, the enhanced tax credit subsidizes the full premium. For people making more than 400 percent of the poverty line — people who were previously ineligible for this subsidy — it caps their premiums to 8.5 percent of their income.)
The enhanced premium tax credits contributed to a record number of insured people in the United States. In February 2021, before Congress expanded the premium tax credits, 11.2 million people were enrolled in health coverage through ACA marketplaces. By 2024, that number shot up to 20.8 million people.
There are many reasons for the dramatic increase in marketplace coverage — including the fact that millions of people were disenrolled from Medicaid coverage after Covid emergency measures lapsed and had to turn to other forms of insurance, including the marketplace — but the enhanced premium tax credit played a critical role. Its expansion was the main reason so many more people were able to enroll in health care coverage from the ACA marketplace, according to the Kaiser Family Foundation.
If Congress allows the enhanced premium tax credits to expire, millions of people will see a noticeable rise in out-of-pocket expenses. Many will likely lose their coverage, and that’s without considering how much more will be at stake if Medicaid gets slashed as well. For low-income families, particularly those who live just above the poverty line, that could be a nightmare.”
https://www.vox.com/policy/387424/enhanced-premium-tax-credit-health-care-marketplace-aca