A Health Care Cost Bomb Is Coming—Unless Congress Acts
“If the enhancements expire at the end of the year, it would cause a lot of disruption in the marketplace, a lot of disruption in people’s lives,” said Claire Heyison, senior analyst for health insurance and marketplace policy at the Center on Budget and Policy Priorities. “In some states, particularly states that haven’t expanded Medicaid, they could see like half of their marketplace enrollees exit the marketplace, which is really disastrous for both marketplace enrollees and for the ACA marketplaces.”
Since the enhanced subsidies were implemented, dramatically reducing premium payments, ACA marketplace enrollment has reached record highs. In 2024, more than 21 million Americans were enrolled in the marketplace, nearly double the number of enrollees in 2020. That number increased to more than 24 million people in 2025, according to KFF. According to the Center on Budget and Policy Priorities, roughly 93 percent of people who receive insurance through the ACA marketplace receive the enhanced subsidies, saving them an average of around $700 in 2024.
Even before the onset of the coronavirus pandemic, then–presidential candidate Joe Biden had campaigned on expanding the Affordable Care Act subsidies. At the time, tax credits to lower premiums were only available to people making between 100 to 400 percent of the federal poverty level. In 2021, the Democratic-led Congress approved temporary subsidies as part of the American Rescue Plan, the massive coronavirus relief package that expanded several social benefit programs. This law made the premium tax credits available to people earning above 400 percent of the federal poverty level, and made them more generous across the board. The following year, the Inflation Reduction Act extended these enhanced subsidies through the end of 2025.
