Become part of the movement for unbiased, accessible election information. Donate today.
Premium tax credits
 |
| Healthcare policy in the U.S. |
|---|
| Obamacare overview |
| Obamacare lawsuits |
| Medicare and Medicaid |
| Healthcare statistics |
|
Premium tax credits (PTC) are tax credits for eligible purchases of health insurance through federal or state healthcare marketplaces. The Affordable Care Act (ACA), sometimes referred to as Obamacare, established the credits in 2010 and they first became available for tax year 2014. Congress has amended the legislation since its introduction, including through the American Rescue Plan Act (ARPA) of 2021, the Inflation Reduction Act (IRA) of 2022, and the One Big Beautiful Bill Act (OBBA) of 2025.
As of September 27, 2025, provisions of the tax credit that were set to expire at the end of 2025 were part of negotiations in Washington ahead of a September 30 funding deadline. Supporters of allowing these provisions to expire say that they are fiscally unsustainable, that there is widespread fraud in the program, and that they serve as a subsidy to large health insurers.[1][2][3] Supporters of extending these provisions say they help millions of Americans afford health insurance that otherwise would go without coverage, and that they reduce premiums and improve care for others.[4][5][6]
- Premium tax credit backgroundBackground information about the premium tax credit, including its general structure and history.
- Changes to the premium tax creditLegislative and regulatory changes related to the PCT, including details about the PCT during specific periods from 2014-2025
- Enrollment and spendingDetails about PCT enrollment and spending from 2017.
- Funding deadline and spending and enrollment projectionsBackground on the September 30 deadline and projections related to spending and coverage under different scenarios.
- ArgumentsArguments about different aspects of the premium tax credit, including about the expiration or extension of the ePTC.
Premium tax credit background
The Affordable Care Act created the premium tax credit when President Barack Obama (D) signed the legislation into law in March 2010. They first became available for tax year 2014 to filers with income between 100% and 400% of the federal poverty level (FPL).[7]
The American Rescue Plan Act (ARPA)—which President Joe Biden (D) signed into law in March 2021 to provide economic relief in response to the COVID-19 pandemic—created the expanded premium tax credit (ePTC) for tax years 2021-2022. The ePTC expanded eligibility to filers with income greater than 400% of the FPL, and reduced the cap on premium contributions for the credit. It is also referred to as the enhanced premium tax credit.
In August 2022, President Biden signed the Inflation Reduction Act (IRA) into law, which extended the ePTC until the end of 2025. The One Big Beautiful Bill Act (OBBA), signed into law by President Donald Trump (R) in July 2025, made further changes to the program. Federal agencies have also changed aspects of the program throughout its existence.
According to the Congressional Budget Office, the premium tax credit “is a refundable credit that helps eligible individuals and families cover the premiums for their health insurance purchased through the Health Insurance Marketplace.”[8] In this context, refundable means that the credit may be used even if the individual owes no tax for the year.[9]
The credit is also advanceable, meaning that payments for the credit may be disbursed throughout the year, not just when the individual files their taxes. This is known as the advanced premium tax credit (APTC), and is the most common method for receiving the credit.(source)
When the tax credit is advanced, the federal government pays the credit directly to the individual’s health insurance provider. Monthly payments are based on an estimate of an individual's income. When the individual files their taxes, the Internal Revenue Service (IRS) reconciles the amount of credit they received with their actual income. If an individual’s income is lower than estimated, they may receive an additional credit. If it is higher, they may owe some of the credit back.
As amended by the IRA, the ePTC will expire at the end of 2025 and the original ACA provisions of the tax credit will take effect.
As of 2025, 22.4 million people received the advanced premium tax credit.[10]
Congress and federal agencies have changed aspects of the premium tax credit since its introduction, including who qualifies for the credit, and the minimum cost an individual or household must spend on health insurance premiums before the credit takes effect.
The chart below displays premium contribution limits from 2014-2025 by income level. It also includes details about these topics post-2025 under the status quo scenario where the ePTC expires at the end of 2025:
| Income | ACA (2014-2020) | ARPA (2021-2022) | IRA (2022-2025) | OBBA (2025) | Post-2025 if ePTC expires |
|---|---|---|---|---|---|
| 100% – 133% FPL | 2.00%-2.7% | ||||
| 133% – 150% FPL | 3.00%-4.14% | ||||
| 150% – 200% FPL | 4.00%-6.52% | 0.00% – 2.00% | 0.00% – 2.00% | 0.00% – 2.00% | |
| 200% – 250 FPL | 6.30%-8.33% | 2.00% – 4.00% | 2.00% – 4.00% | 2.00% – 4.00% | |
| 250% – 300% FPL | 8.05%-9.50% | 4.00% – 6.00% | 4.00% – 6.00% | 4.00% – 6.00% | |
| 300% – 400% FPL | 6.00% – 8.50% | 6.00% – 8.50% | 6.00% – 8.50% | ||
| Over 400% FPL |
See below for details about changes to the PTC throughout its existence.
Premium tax credit rules under the Affordable Care Act (2014-2020)
As originally established, eligibility for premium subsidies was restricted to households with income between 100% and 400% of the FPL who did not otherwise have access to “affordable, minimum essential coverage.”[11] The ACA established six income tiers and stipulated the maximum premium contribution for each income level before the PTC became available.
The ACA linked the size of the premium credit to the second-lowest-cost silver plan available to the purchaser, minus the required contribution of the individual or household. This meant that higher income households generally received a lower credit. Households with income below 100% of the FPL were eligible for Medicaid in states that expanded Medicaid eligibility as part of the ACA, but may not have been eligible in states that chose not to expand Medicaid after the Supreme Court ruled the expansion was optional for states in 2012.
The ACA also established caps on the amount of money that could be refunded for each income level.
| Income | Repayment caps, individual filer / other filers[12] |
|---|---|
| 100% – 133% FPL | $300-$325 / $600-$650 |
| 133% – 150% FPL | $300-$325 / $600-$650 |
| 150% – 200% FPL | $300-$325 / $600-$650 |
| 200% – 250 FPL | $750-$800 / $1500-$1600 |
| 250% – 300% FPL | $750-$800 / $1500-$1600 |
| 300% – 400% FPL | $1250-$1350 / $2500 - $3650 |
| Over 400% FPL | Ineligible (2014-2019) / Full repayment (2021-2025) |
Premium tax credit rules under the ARPA (2021-2022)
The American Rescue Plan Act, which President Joe Biden (D) signed on March 11, 2021. For tax years 2021-2022, ARPA:
- Removed the eligibility cap for premium tax credits for households earning more than 400% of the FPL, and;
- Lowered the premium contribution limit for the PTC at all income levels.
This created the expanded premium tax credit (ePTC). Individuals and households with income above 400% FPL became eligible for the tax credits if they were otherwise ineligible for government programs such as Medicaid or Medicare, and they were unable to otherwise purchase healthcare whose premiums did not exceed a certain percentage of household income.
With respect to premium contribution caps, the legislation eliminated all premium payments for individuals and households claiming income between 100% and 150% of the FPL. It also reduced the highest premium contribution limit from around 9% of income to 8.5% of income. Under the ACA, the highest premium contribution percentage applied to income levels between 300%-400% of the FPL, while ARPA applied the highest rate to income levels above 400%.
ARPA also created a one-time special enrollment period (SEP) in 2021 and suspended all repayment of excess credits for tax year 2020 as part of COVID-19 relief.[13][11]
Premium tax credit rules after the IRA (2022-2025)
The Inflation Reduction Act, which President Joe Biden (D) signed into law on August 16, 2022, extended the expanded premium tax credit for three more years, until the end of 2025. The IRA did not make any other changes to the credit.
In 2022, the Centers for Medicare and Medicaid Services (CMS) and the IRS each finalized regulatory changes related to the program, including establishing a special enrollment period that allowed filers to claim the advanced PTC based on expected changes in income.
Income-based special enrollment period
On March 21, 2022, CMS issued technical assistance that established a special enrollment period for filers whose expected income dropped below 150% FPL.[14] Under the ACA, filers could enroll in insurance and claim an advanced PTC during only after a qualifying event, which did not include expected changes in income. According to CMS, “Consumers who qualify for the 150% SEP don’t need to submit documentation to confirm their SEP eligibility. CMS notes that consumers with open or new data matching issues (DMI) are still required to submit documentation to the Marketplace to keep their financial help.”[14]
In 2025, Congress repealed the statute that authorized this change through the OBBA and ended the possibility of receiving an advanced PTC on the basis of income-related special enrollment.
| ACA (2014-2020) | ARPA (2021-2022) | IRA (2022-2025) | OBBA (2025) | Post-2025 if ePTC expires | |
|---|---|---|---|---|---|
| Income-based special enrollment availability | No | Authorized, not in use. | Yes, APTC available through SEP when expected income falls below 150% FPL. | No | No |
Family glitch
In 2022 the IRS issued a final rule that changed the affordability test for an individual filing with dependents. Previously, the test for affordability was dependent on the cost for a self-only plan for the individual. This meant that if an individual had access to an affordable self-only plan, but did not have access to an affordable plan that covered themselves and their dependents, they were unable to claim a premium tax credit for coverage. The updated rule allowed the household to claim the credit if the lowest-cost plan available that covered the filer and their dependents was greater than the affordability threshold. This rule change is known as the “family glitch fix.”[15]
Premium tax credit changes in the One Big Beautiful Bill Act (2025)
The One Big Beautiful Bill Act, which President Donald Trump (R) signed into law on July 4, 2025, made further changes to the premium tax credit program, but did not change eligibility or premium contribution caps of the ePTC. The OBBA:[16]
- Eliminated statute that enabled special enrollment periods based solely on income projections;
- Required exchanges to “establish procedures to ensure that eligibility determinations are verified in advance of the first month of coverage”;
- Eliminated caps on repayments for excess advanced PTC payments for all income levels in future years;
- And, restricted eligibility for certain immigrants with legal status.
The Centers for Medicaid and Medicare Services codified these and other changes to the PCT through the "Marketplace Integrity and Affordability Final Rule" published on June 20, 2025.[17] See here for a complete summary of that rule.
Enrollment and spending
Marketplace enrollment and APTCs
Enrollees in health insurance using advanced premium tax credits more than doubled between 2021 and 2025, to more than 20 million individuals. As of 2025, 92% of all consumers who purchased health insurance through public marketplaces received an advanced premium tax credit, up from 82.7% in 2017.[10]
Purchasers of health insurance using advanced PTCs stayed relatively level between 2017-2021, ranging between 9.6 million and 10.2 million people during the period. In 2022, the first full year of expanded eligibility for the tax credit, the number of purchasers using the tax credits increased by more than 2 million people to 13 million. In 2025, that number more than doubled the pre-expansion average, with 22.4 million consumers receiving an advanced premium tax credit.[10]
Spending
Spending on the program has increased alongside the expanded eligibility and increased enrollment.[18] The CBO reported that outlays for the premium tax credit were $49 billion in 2017. For 2021, the first year of the ePTC, the CBO reported outlays for the program as $71 billion. For 2024, the most recent year of available data, the CBO reported the program cost at $98 billion.[19][20][21][22][23][24][25][26]
September 30, 2025, funding deadline and projections
In July 2025, Congress passed the One Big Beautiful Act through the budget reconciliation process and President Donald Trump (R) signed the bill into law. Budget reconciliation is a legislative process that can be used to override the filibuster and expedite the approval of a package of legislation in Congress that changes spending, revenues, or the debt limit.
While the One Big Beautiful Act set a budget and spending framework for the federal government, it did not appropriate any funds. Instead, Congress still needs appropriate money to federal agencies for the upcoming fiscal year, or pass a continuing resolution that temporarily extends funding.
To keep the government open, Congress must either pass the required 12 appropriations bills before the fiscal year ends, or pass a continuing resolution which “may be enacted to provide temporary funding to continue certain programs and activities until action on the regular appropriations acts is completed.”[27] As of September 25, 2025, none of the 12 appropriations bills have passed Congress.
A continuing resolution may be clean, meaning that it extends existing appropriations at current levels, or it may contain additional provisions, such as extensions of programs set to expire, or other policy riders.[28]
Among key issues in the ongoing debates about what sort of funding deal Congress will pass is whether to extend the enhanced premium tax credit, or to let the ePTC expire and revert back the structure the ACA originally established for the credit.[29][30][31][32]
Spending and coverage projections
EPTC expiration projections
Budget
In July 2024, the CBO and the Joint Committee on Taxation (JCT) estimated that the cost of the expanded tax credit in 2025 would be $107 billion.[26]
In the same report, the CBO provided estimated yearly costs for the premium tax credit under the scenario that the ePTC expires at the end of 2025. They estimate that spending on the program will drop by $23 billion between 2025-2026 to $84 billion. They also estimate that the spending on the program will reach 2025 levels again in 2033, and surpass them in 2034.[26]
| 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 | 2034 |
|---|---|---|---|---|---|---|---|---|---|
| $107 | $84 | $86 | $89 | $91 | $93 | $97 | $101 | $107 | $111 |
Marketplace and PCT enrollment
The CBO estimated that overall marketplace plan enrollment would fall by 3.9 million from 22.8 to 18.9 million in 2026, the first year after the expiration of the eTPC. The CBO estimated that the population of marketplace enrollees that do not receive a subsidy would more than double from 2025-2026, from 1.5 to 3.2 million people. The CBO estimated that marketplace enrollment would continue to shrink until 2033.[26]
| Participation information | 2025 | 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 | 2034 |
|---|---|---|---|---|---|---|---|---|---|---|
| Total marketplace enrollment | 22.8 | 18.9 | 16.0 | 15.8 | 15.7 | 15.4 | 15.4 | 15.4 | 15.9 | 16.0 |
| Subsidized enrollment | 21.3 | 15.7 | 14.1 | 13.8 | 13.7 | 13.4 | 13.4 | 13.4 | 13.8 | 13.9 |
| Unsubsidized enrollment | 1.5 | 3.2 | 2.0 | 2.0 | 2.0 | 2.0 | 2.0 | 2.0 | 2.1 | 2.1 |
Nationwide premiums and PTC size
The CBO provided an estimate of changes to nationwide premiums for the average annual benchmark plan from 2025-2034 for a 21 year-old marketplace enrollee. They estimated that premium prices would increase by 9% the first year after the expiration of the ePTC, and by 56.3% from 2025 to 2034, from $4,780 to $7,470. They also estimated the average premium tax credit amount per subsidized marketplace enrollee would increase by 51.2% during the same period, from $6,190 to $9,360.Cite error: Closing </ref> missing for <ref> tag In a December 2024 letter, the CBO wrote, "Without a permanent extension, CBO estimates, the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026-2034 period."[33]
EPTC extension projections
The CBO provided estimates of the net increase in spending between 2026-2034 under the scenario that Congress makes the ePTC permanent or extends it for the duration of that period. They estimate that extending the ePTC during that period would result in a net increase in direct spending of $383.5 billion.[34]
| 2026 | 2027 | 2028 | 2029 | 2030 | 2031 | 2032 | 2033 | 2034 |
|---|---|---|---|---|---|---|---|---|
| $26.6 | $26 | $27.4 | $28.7 | $30.2 | $32.5 | $32.3 | $34.2 | $36.3 |
Arguments
- Argument in favor of allowing the expanded premium tax credit to expire
- Arguments in favor of extending or making the expanded premium tax cut permanent
Claim: The ePTC increased a direct taxpayer subsidy to insurers.
This claim argues that because the ePTC increased payments directly to insurers on behalf of household that already had subsidized coverage, and millions of individuals who claim the credit never receive care through their insurance, the ePTC is effectively direct subsidy paid to insurers by taxpayers for no increase in coverage.
- In a May 2021 paper published by the Heritage Foundation, Doug Badger wrote that “one significant effect of [the ePTC] was to enlarge government payments to insurance companies on behalf of people who already have subsidized coverage.”[35]
- In a September 2025 report co-published by the Foundation for Government Accountability and Paragon Health Institute, Brian Blase wrote: “A whopping 40 percent of enrollees in fully subsidized plans had no claims in 2024. In 2024 alone, taxpayers sent at least $35 billion to insurers for people who paid no premiums and never used their plan.”[36]
Claim: The ePTC disproportionately benefited high-earners who did not need the assistance.
This claim argues that by removing the income cap for the premium tax credit, the ePTC created a taxpayer subsidy for high-earners who did not need it.
- In a May 2021 paper published by the Heritage Foundation, Doug Badger wrote: “Those with incomes between 400 percent and 600 percent of the FPL receive average monthly ARPA subsidies of $213, a figure that is nearly seven times as high as the increased subsidy provided by ARPA to those with incomes less than 150 percent of the FPL. The wealthiest recipients—those with incomes exceeding 600 percent of the FPL—get average ARPA subsidies nearly two- and-a-half times as large as the lowest-income recipients.”[35]
- In a May 2024 letter, Rep. Jodey Arrington and (R) Rep. Jason Smith (R) wrote: "It is particularly concerning that, by removing the income eligibility limit, some of our nation’s highest earners are now eligible for government assistance."[37] In a separate statement, the representatives wrote that "it is unconscionable that Democrats would continue to push for massive taxpayer-funded handouts to the wealthy and large health insurance companies."[34]
- In an August 2025 report published by the Economic Policy Innovation Center, Matthew Dickerson wrote: "Higher-income households also reap significant new taxpayer subsidies thanks to the Biden COVID Credits. A four-person household earning $96,500 (300 percent of the federal poverty level) would have had an expected premium contribution of just under 10 percent of monthly income under pre-Biden Obamacare, or about $790 per month for a benchmark plan. The Biden COVID Credits reduced the expected contribution to 6 percent, or $482 per month. Taxpayers pay for this difference. This means about $3,700 annually in new taxpayer-funded Biden COVID Credit subsidies for a household taking in nearly $100,000 per year."[38]
Claim: The PTC program is rife with fraud and the ePTC made the problem worse
This claim argues that there has been fraud in the PTC program since its inception, but the ePTC created incentives that worsened fraud, including the introduction of of zero-premium (or fully subsidized) plans.
- In a September 2025 report co-published by the Foundation for Government Accountability and Paragon Health Institute, Brian Blase wrote that “nearly half of exchange enrollees in 2025 claimed income that made them eligible for zero-premium plans—a result of large incentives for enrollees, enrollment intermediaries, and insurers to cheat.”[36]
- In a July 2025 report from the Paragon Health Institute, Brian Blase and Jackson Hammond wrote: "Unscrupulous brokers have large incentives to encourage enrollees to misstate income. Brokers are paid a commission by the insurance company for every enrollee they sign up. No-cost premiums are a huge selling point, since many individuals will not pay for health insurance if there is any premium."[39]
- In April 2025, a Florida executive pleaded guilty to a multi-million dollar fraud scheme based on enrollment in zero-premium plans. In a press release, the IRS wrote that the scheme relied on “fraudulent applications to enroll consumers in Affordable Care Act insurance plans (ACA plans) that were fully subsidized by the government. The purpose of the scheme was to obtain millions of dollars in commission payments from the insurance company that operated the ACA plans. The federal government paid at least $133,900,000 in subsidies for fraudulently enrolled individuals.”[40]
Claim: Making the ePTC permanent would disincentivize insurers from improving plan value, and would incentivize employers to drop coverage and disincentivize.
- In a May 2021 paper published by the Heritage Foundation, Doug Badger wrote: “Once employers know that government will subsidize coverage for workers regardless of their income, they may have fewer inhibitions about dumping their employees into the exchanges, where the government pays a portion of the premiums.”[35]
- In a September 2025 report co-published by the Foundation for Government Accountability and Paragon Health Institute, Brian Blase wrote that the ePTC “give insurers even less incentive to design plans that people truly value because taxpayers cover nearly all of the costs.”[36]
Claim: The ePTC is a was meant to provide COVID-19 relief that has become a new entitlement
This claim argues that the ePTC was meant to provide temporary relief related to COVID-19 and has become a $100 billion annual program that is projected to continue growing. It argues that the government has better alternatives to facilitate coverage while reducing the deficit.
- In a September 2025 report co-published by the Foundation for Government Accountability and Paragon Health Institute, Brian Blase wrote: “Increasing choice and competition through alternative coverage options, such as short-term limited-duration plans and Association Health Plans, combined with continued progress on price transparency, are ways to strengthen market forces in a sector that has been strangled by government. Moreover, Congress can significantly reduce premiums and subsidies by funding ObamaCare’s cost-sharing reduction (CSR) program”[36]
- In a September 2025 letter to Congress, Thomas Aiello, senior director at the National Taxpayers Union, wrote: "This expanded credit, created as a temporary measure during President Biden’s COVID spending spree, continues to burden taxpayers and distort health care markets."[41]
- In an August 2025 report published by the Economic Policy Innovation Center, Matthew Dickerson wrote: "The subsidies were always meant to be temporary and should expire along with other misguided, costly, and temporary COVID policies."[38]
Claim: The ePTC directly enables millions of Americans to afford health insurance
This claim argues that the the increase in enrollment in marketplace plans after the creation of the ePTC shows that it was the difference that enabled millions of people to purchase health insurance, and that allowing the ePTC would directly lead to loss of coverage for millions.
- Jeanne Lambrew and Aviva Aron-Dine, writing in an August 2025 brief published by the Commonwealth Fund, wrote: “Some of the increased enrollment resulted from lifting the subsidy’s upper income limit of 400 percent of the federal poverty level (FPL)... in recent years, however, the greatest growth was in enrollees with incomes below 150 percent of FPL, who became eligible for zero-premium marketplace plans under the enhanced tax credit schedule… The rapid growth in marketplace enrollment over this period was accompanied by a significant expansion in coverage. The U.S. hit record-high coverage rates in 2022 and 2023, and coverage remained at a historic high in the first half of 2024.”[4]
- In a July 2025 fact sheet, the American Hospital Association wrote: "The tax credits helped millions of Americans purchase affordable commercial health care coverage. The expiration of this policy would effectively be a tax increase of $700 on average for millions of people across the nation. ... The expiration of the enhanced tax credits will result in 4.2 million people becoming uninsured by 2034."[42]
Claim: Short-term deficit relief would give way to higher federal costs elsewhere as a result of the increase in Americans without coverage.
- Jeanne Lambrew and Aviva Aron-Dine, writing in an August 2025 brief published by the Commonwealth Fund, wrote: “Failing to extend current enhanced premium tax credits, otherwise lowering tax credit values, and shifting taxpayer dollars to savings accounts rather than coverage would further erode coverage gains. The short-term federal financial gain of such proposals could lead to higher federal costs by creating greater numbers of uninsured, requiring more government funding for uncompensated care, and worsening health outcomes in the United States.”[4]
This claim argues that the ePTC enlarged and widened the risk pool for insurers, partially by attracting younger, healthier consumers. This led to an overall reduction in the growth of premiums, and eliminating the ePTC would create higher premiums for on and off marketplace consumers.
- Natasha Murphy, the health policy director at the Center for American Progress wrote in a February 2025 article that “the program helped attract more younger, healthier enrollees to the ACA marketplace, strengthening the overall risk pool.”[43]
- A June 2025 report from Peterson-KFF Health System Tracker based on conversations with insurers said: “insurers stated that the expiration of enhanced tax credits will cause premiums to increase and have publicly quantified the expiration’s effects. Among the insurers that publicly quantified the impact of the expiration of the premium tax credits, the projected increases on top of expected annual premium increases range from about 1% to 7%, with the average projected premium impact being about 4%, ... healthier people are expected to drop their coverage in larger numbers as a result of increases in their net premium payments.”[44]
Claim: The elimination of the ePTC would have negative economic consequences across the United States
This claim argues that eliminating the ePTC would lead job losses in the health care sector and reduce overall economic wellbeing and access to health care across the economy.
- In a December 2024 brief published by the Urban Institute, the authors wrote that as a result of eliminate the ePTC, “lower spending on health care services means lower revenue for health care providers and fewer services rendered, the resulting decline in revenue for providers in these communities could have adverse consequences for providers, particularly hospitals that are already financially at-risk.”[45]
- In a March 2025 press release, Leighton Ku, professor of health policy and management at George Washington University, said: “Eliminating federal premium tax credits will have serious economic repercussions nationwide. States will face deep job losses, particularly in health care, along with billions in lost economic activity. Without these subsidies, families will struggle to afford coverage, businesses will take a hit, and state and local budgets will be stretched even thinner... Hospitals and health providers would face major revenue losses. Some providers would be forced to close or reduce services, leading to longer wait times, fewer available providers — especially in rural areas — and higher uncompensated care costs.”[46]
- In a March 2025 report co-published by the Commonwealth Fund and the GW Milken Institute of School of Public Health, the authors wrote that "health providers will need to cut jobs — some could even close due to loss of revenue. This would lower access to health care overall, even for people who remain insured… Ending enhanced PTCs would reduce state economies across the nation. Total state gross domestic products (GDPs) would fall by $34.1 billion and total economic output would fall by $57.0 billion. The net economic harm for states would therefore be much larger than the loss of federal funds ($26.1 billion) to states.”[4] A summary of the report said: "Hospitals and health providers would face major revenue losses. Some providers would be forced to close or reduce services, leading to longer wait times, fewer available providers — especially in rural areas — and higher uncompensated care costs."[46]
Recent news
The link below is to the most recent stories in a Google news search for the terms premium tax credit. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.
See also
Footnotes
- ↑ The Heritage Foundation, “Obamacare Subsidies: Six Reasons Congress Should Not Make Temporary Increases Permanent,” May 26, 2021
- ↑ The American Enterprise Institute, “Tax Credit Nation—Politicians Are Casting New Spending as 'Tax Cuts,' Hiding Their True Cost,” January 11, 2024
- ↑ Paragon Health Institute, “Policy Changes Needed to Reduce Massive Improper Affordable Care Act Subsidy Expenditures,” July 2, 2025
- ↑ 4.0 4.1 4.2 4.3 The Commonwealth Fund, “Health Insurance Tax Credits: Their Unexpected Effectiveness, and Policies to Support Them,” August 13, 2025 Cite error: Invalid
<ref>tag; name "cmwth" defined multiple times with different content Cite error: Invalid<ref>tag; name "cmwth" defined multiple times with different content Cite error: Invalid<ref>tag; name "cmwth" defined multiple times with different content - ↑ KFF, “Why Might Republicans Consider Extending Obamacare Tax Credits?” September 25, 2025
- ↑ Urban Institute, “Hospitals, Physicians, and Other Stakeholders Face Billions of Dollars in Uncompensated Care Costs and Lost Revenue if Enhanced ACA Tax Credits Expire,” December 13, 2024
- ↑ As of September 2025, the FPL in the contiguous 48 United States was $15,650, and slightly higher in Alaska and Hawaii.
- ↑ Internal Revenue Service, “The Premium Tax Credit – The basics,” accessed September 25, 2025
- ↑ Cornell Law School Legal Information Institute, “26 U.S. Code § 36B - Refundable credit for coverage under a qualified health plan,” accessed September 25, 2025
- ↑ 10.0 10.1 10.2 Kaiser Family Foundation, “Marketplace Plan Selections with Financial Assistance,” accessed September 25, 2025
- ↑ 11.0 11.1 Internal Revenue Service, “Questions and answers on the Premium Tax Credit,” accessed September 25, 2025 Cite error: Invalid
<ref>tag; name "irsquestions" defined multiple times with different content - ↑ For tax year 2020, Congress waived repayment for all income levels as part of COVID-19 relief through the ARPA. In 2025, Congress eliminated repayment caps starting in 2025 through the OBBA.
- ↑ Centers for Medicare & Medicaid Services, “2021 Special Enrollment Period in response to the COVID-19 Emergency,” January 28, 2021
- ↑ 14.0 14.1 Centers for Medicare & Medicaid Services, “Marketplace Stakeholder Technical Assistance Tip Sheet on the Monthly Special Enrollment Period for Advance Payments of the Premium Tax Credit – Eligible Consumers with Household Income at or below 150% of the Federal Poverty Level,” October 28, 2022
- ↑ Federal Register, “Affordability of Employer Coverage for Family Members of Employees,” October 13, 2022
- ↑ Congress.gov, “119th Congress - H.R.1 - One Big Beautiful Bill Act,” accessed September 25, 2025
- ↑ Center for Medicaid and Medicare Services, “2025 Marketplace Integrity and Affordability Final Rule,” June 20, 2025
- ↑ All reported and projected spending is in nominal terms, unless otherwise stated.
- ↑ Congressional Budget Office, “The Budget and Economic Outlook: 2018 to 2028,” April 2018
- ↑ Congressional Budget Office, “The Budget and Economic Outlook: 2019 to 2029,” August 2019
- ↑ Congressional Budget Office, “An Update to the Budget Outlook: 2020 to 2030,” September 2020
- ↑ Congressional Budget Office, “Additional Information About the Updated Budget and Economic Outlook: 2021 to 2031,” July 2021
- ↑ Congressional Budget Office, “The Budget and Economic Outlook: 2022 to 2032,” May 2022
- ↑ Congressional Budget Office, “The Budget and Economic Outlook: 2023 to 2033,” February 2023
- ↑ Congressional Budget Office, “An Update to the Budget and Economic Outlook: 2024 to 2034,” June 2024
- ↑ 26.0 26.1 26.2 26.3 Congressional Budget Office, “The Premium Tax Credit and Related Spending,” July 2024
- ↑ Congress.gov, “Continuing Resolutions: Overview of Components and Practices,” accessed September 25, 2025
- ↑ Economic Policy Innovation Center, “EPIC Explainers: CRs,” September 12, 2023
- ↑ AP News, “Democrats stake out opposition to spending bill, raising threat of a shutdown,” September 16, 2025
- ↑ Axios, “Scoop: Democrats lean into shutdown fight with alternative funding plan,” September 16, 2025
- ↑ Politico, “Senate Republicans ready Obamacare rescue,” September 15, 2025
- ↑ The Wall Street Journal, “Democrats Name Their Price for Avoiding Government Shutdown,” September 13, 2025
- ↑ Congressional Budget Office, “Re: The Effects of Not Extending the Expanded Premium Tax Credits for the Number of Uninsured People and the Growth in Premiums,” December 5, 2024
- ↑ 34.0 34.1 United States House of Representatives Committee on Budget, “CBO and JCT Confirm the Debt-Driving Cost of Biden’s Plan to Permanently Expand Obamacare Subsidies for the Wealthy,” June 24, 2024
- ↑ 35.0 35.1 35.2 The Heritage Foundation, "Obamacare Subsidies: Six Reasons Congress Should Not Make Temporary Increases Permanent," May 26, 2021
- ↑ 36.0 36.1 36.2 36.3 The Foundation for Government Accountability, "Biden’s COVID Credits Are an ObamaCare Expansion That Congress Should Allow to Expire," September 3, 2025
- ↑ United States House of Representatives Committee on Budget, “JCT CBO letter,” accessed September 25, 2025
- ↑ 38.0 38.1 Economic Policy Innovation Center, “Let Biden’s COVID Credits Expire,” August 13, 2025
- ↑ Paragon Health Institute, "Policy Changes Needed to Reduce Massive Improper Affordable Care Act Subsidy Expenditures," July 2, 2025
- ↑ Internal Revenue Service, "Executive vice president of insurance brokerage pleads guilty in $133m affordable care act fraud scheme," April 18, 2025
- ↑ National Taxpayers Union, “Open Letter to Congress: Allow COVID-Era Enhanced Obamacare Credits to Expire," September 8, 2025
- ↑ American Hospital Association, "Fact Sheet: Enhanced Premium Tax Credits," July 2025
- ↑ Center for American Progress, "5 Ways the ACA’s Enhanced Premium Tax Credits Have Improved Health Coverage Affordability and Access," February 18, 2025
- ↑ Peterson-KFF Health System Tracker, "Early indications of the impact of the enhanced premium tax credit expiration on 2026 Marketplace premiums," June 3, 2025
- ↑ Urban Institute, "Costs and Lost Revenue if Enhanced ACA Tax Credits Expire," December 13, 2024
- ↑ 46.0 46.1 GW Milken Institute of School of Public Health, "NEW REPORT: Loss of Health Insurance Premium Tax Credits Projected to Cost States $34 Billion in GDP and More Than $2 Billion in Lost Tax Revenue," March 3, 2025
