Out-of-pocket premiums for health coverage through the Affordable Care Act (ACA) health insurance marketplaces will double starting on January 1, 2026. The Senate will vote this week to prevent this from happening. The House has no such vote scheduled.
For the past year and a half, The Century Foundation has documented the benefits of the enhanced premium tax credits and warned of the consequences of their loss. We have done so through numerous reports, Congressional testimonies, speeches, town halls, and media interviews.
The evidence is clear: enhanced premium tax credits doubled marketplace enrollment, helped achieve a record-high U.S. health coverage rate, improved affordability, and did so at a federal cost in line with similar programs.
Ending them will cause a record-high increase in out-of-pocket premiums for a major health program, add costs for families that outstrip food and rent cost hikes, and disproportionately affect certain populations such as rural residents.
Below are six figures highlighting the benefits of ACA tax credits and foreshadowing the harms if they expire.
Benefits of Enhanced Premium Tax Credits
Figure 1.
Figure 2.
Figure 3.
For more on the benefits of the ACA enhanced premium tax credits, see The Century Foundation’s August 2024 report.
Harms If Enhanced Premium Tax Credits Are Lost
Figure 4.
Figure 5.
Figure 6.
For more on the harms that will result if the enhanced premium tax credits are lost, see The Century Foundation’s August 2024 report, August 2025 data tool, August 2025 commentary, September 2025 commentary, October 2, 2025 commentary, and October 8, 2025 commentary.
Tags: affordable care act, health care costs, healthcare premiums, enhanced premium tax credits
Why It Matters: Congress’s Last Chance to Prevent Health Premium Shocks in January
Out-of-pocket premiums for health coverage through the Affordable Care Act (ACA) health insurance marketplaces will double starting on January 1, 2026. The Senate will vote this week to prevent this from happening. The House has no such vote scheduled.
For the past year and a half, The Century Foundation has documented the benefits of the enhanced premium tax credits and warned of the consequences of their loss. We have done so through numerous reports, Congressional testimonies, speeches, town halls, and media interviews.
The evidence is clear: enhanced premium tax credits doubled marketplace enrollment, helped achieve a record-high U.S. health coverage rate, improved affordability, and did so at a federal cost in line with similar programs.
Ending them will cause a record-high increase in out-of-pocket premiums for a major health program, add costs for families that outstrip food and rent cost hikes, and disproportionately affect certain populations such as rural residents.
Below are six figures highlighting the benefits of ACA tax credits and foreshadowing the harms if they expire.
Benefits of Enhanced Premium Tax Credits
Figure 1.
Figure 2.
Figure 3.
For more on the benefits of the ACA enhanced premium tax credits, see The Century Foundation’s August 2024 report.
Harms If Enhanced Premium Tax Credits Are Lost
Figure 4.
Figure 5.
Figure 6.
For more on the harms that will result if the enhanced premium tax credits are lost, see The Century Foundation’s August 2024 report, August 2025 data tool, August 2025 commentary, September 2025 commentary, October 2, 2025 commentary, and October 8, 2025 commentary.
Tags: affordable care act, health care costs, healthcare premiums, enhanced premium tax credits