Imagine facing a daunting diagnosis like cancer without the reassurance that you can afford the care you need. For 21 million Americans, this isn’t a hypothetical—it’s a real prospect. Today, Congress stands at a crossroads: will they let the enhanced healthcare tax credit expire on Dec. 31, 2025, or will they protect what has become a lifeline?
Every year, millions of Americans are forced to make difficult decisions between paying for healthcare and other essential expenses like groceries or rent. According to recent surveys, nearly 40% of adults in the United States report having delayed or skipped medical care due to cost concerns; among these, more than half say they had to choose between medical bills and basic necessities, such as food or housing. In communities across the nation, stories abound of families who must weigh the health of their children against keeping a roof over their heads or putting meals on the table.
This stark reality underscores the urgency for Congress to extend the healthcare tax credit. Without this support, the number of people caught in painful dilemmas will grow, threatening not just individual well-being but the broader fabric of American society, as a high uninsured rate leads to the potential for increased absenteeism, decreased productivity, and a rise in unemployment.
The choice before Congress reaches far beyond dollars and cents—it touches the very spirit of American opportunity and self-reliance. A healthy market thrives when families have the freedom to choose affordable healthcare, when competition flourishes, and when government serves as a safeguard rather than an obstacle. At stake is the ability of millions of hardworking Americans to pursue their own American dream with the dignity and independence that comes from access to care.
Since Congress strengthened the healthcare tax credit, more than 16 million Americans have gained affordable, quality coverage; more than 23 million Americans are enrolled in marketplace coverage, including 4.2 million small business owners and 2.6 million children, and more than 21 million, or 93%, rely on the tax credit to afford that coverage. Every parent who brings their child to a check-up, every heart attack survivor who receives follow-up care, every young adult who manages asthma or diabetes—these are lives transformed by access to care. In fact, through the tax credit, we achieved the lowest rate of uninsured Americans in history.
The consequences of congressional inaction aren’t theoretical; they’re immediate and personal for those who purchase their own coverage in the individual marketplace. For example, someone earning about $26,000 a year will see a spike of more than 500%, or about $1,225 more, for a typical plan. An average family of four that earns $64,000 a year will face a 210% premium increase—more than $2,500 a year. And a 60-year-old couple earning $83,000 will have to pay as much as $17,500 more.
Americans who are covered through the marketplaces will see this sticker shock in a matter of weeks, when rates are finalized and they start shopping.
The data is clear. Without the enhanced healthcare tax credit, more than 5 million people are projected to lose health insurance entirely. This includes one in four marketplace enrollees living with chronic conditions. And, while most people don't have major health issues every year, the tax credit helps them to purchase affordable coverage when they need it.
Hospitals and community clinics in rural areas, where people feel the greatest benefits from the tax credit, will struggle under the weight of more uninsured patients and care that goes unpaid. Rural Americans will see their premiums go up 28% more than those in urban areas and rural states can expect a 37% increase in their uninsured population, threatening the viability of rural healthcare access points, which rely on insured patients to keep their doors open and provide critical access in rural communities.
Americans with employer-provided coverage will feel the pain as well. A National Bureau of Economic Research study noted that when people lose insurance, hospitals deliver more uncompensated care, pushing health insurance companies for higher reimbursement rates for employer-based coverage to make up for losses. These higher rates are then passed on to employers and employees in the form of higher premiums and deductibles.
Congress can avoid these consequences by extending the enhanced tax credit in the upcoming government spending bill, protecting millions of Americans in every state from higher costs.
This is a moment for leadership, not partisan politics. Americans everywhere want affordable coverage for their families, regardless of ZIP code, background or political affiliation. By extending the health tax credit, Congress would bring stability and peace of mind to households, small businesses and communities across the country.
Time is running out; Congress must act this fall to prevent the tax credit from expiring and putting coverage out of reach for millions. Extending the tax credit is good for the physical, social and economic health of all Americans.
Kim Keck is president and CEO of the Blue Cross Blue Shield Association.