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Millions of Americans could lose coverage if the GOP allows the Affordable Care Act's enhanced premium tax credits to expire.
As Congress negotiates the extension of Affordable Care Act tax credits, a nonpartisan government analysis warned this week that letting the ACA subsidies expire next year would cause millions of Americans to lose health coverage in the years ahead.
The American Rescue Plan Act "reduced the maximum amount eligible enrollees must contribute toward premiums for health insurance purchased through the marketplaces established by the Affordable Care Act, and it extended eligibility to people whose income is above 400% of the federal poverty level," wrote Congressional Budget Office (CBO) Director Phillip Swagel.
His Thursday letter came in response to an inquiry from U.S. Sens. Jeanne Shaheen (D-N.H.) and Ron Wyden (D-Ore.) along with Reps. Richard Neal (D-Mass.) and Lauren Underwood (D-Ill.) about "the effects on health insurance coverage and premiums that will result from not extending—either for one year or permanently—the expanded premium tax credit structure."
"Without an extension through 2026, CBO estimates, the number of people without insurance will rise by 2.2 million in that year," Swagel said. "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."
"Without an extension through 2026, CBO estimates, gross benchmark premiums will increase by 4.3%, on average, for that year," the director continued. "Without a permanent extension, CBO estimates, gross benchmark premiums will increase by 4.3% in 2026, by 7.7% in 2027, and by 7.9%, on average, over the 2026-2034 period."
"If Congress fails to act, healthcare will become out of reach for millions of Americans, leaving middle-class families to struggle and choose between seeing a doctor or keeping a roof over their heads or groceries in the fridge."
The analysis comes as the world braces for GOP control of Congress and the White House, with President-elect Donald Trump set to be sworn in next month. Since President Barack Obama signed the ACA—also known as Obamacare—in 2010, elected Republicans including Trump have repeatedly tried to gut or fully repeal the law.
In response to the CBO report, Wyden said, "This is a stark preview of healthcare under Donald Trump: higher insurance premiums for families who buy health coverage on their own, and more uninsured Americans who can't afford health insurance at all."
"Republicans have an opportunity to end their ideological crusade against the Affordable Care Act and work in a bipartisan manner to make healthcare more affordable for working families, but instead they seem poised to hand another big tax break to corporations and the wealthy," warned Wyden, the outgoing Senate Finance Committee chair.
In September, Shaheen and Underwood introduced a bill to make the ACA's enhanced premium tax credits permanent. Shaheen said Thursday that the "new data from CBO confirms what we feared: if Congress fails to extend these tax credits, healthcare costs will skyrocket for millions of families and 3.8 million Americans will lose coverage entirely."
"At a time when Americans are already facing higher prices, we should do everything we can to lower costs when and where we can," she added. "It's time we pass my Health Care Affordability Act to permanently extend the tax credits so many families rely on."
Advocacy groups echoed demands for Congress to at least extend the subsidies following the CBO's findings.
"If Congress fails to act, healthcare will become out of reach for millions of Americans, leaving middle-class families to struggle and choose between seeing a doctor or keeping a roof over their heads or groceries in the fridge," said Protect Our Care executive director Brad Woodhouse in a statement.
"Instead of helping hardworking families, Republicans have opposed measures to lower healthcare costs and have instead focused on delivering tax breaks to big corporations and the wealthiest Americans," he continued. "Health coverage gives people peace of mind knowing they won't go bankrupt over an injury or illness. Democrats stand ready to extend the tax credits to ensure everyone has access to affordable healthcare. It's time for Republicans to get on board."
While the CBO found with the expiration of the credits, "on average, those with health insurance will see their unsubsidized gross monthly premiums increase by as much as 8% each year," Anthony Wright, executive director of Families USA, pointed out that "for people who now receive premium assistance, the increases will be far steeper."
"Taking into account the cuts in premium assistance, nonpartisan organizations, such as the Center on Budget and Policy Priorities, report that people will experience estimated premium increases ranging from 41% to 218%, with a median increase of 91%—a near doubling of their monthly costs," he explained.
"For nearly 20 million Americans, these enhanced tax credits have been the difference between getting access to the healthcare and coverage they need or going without it," Wright stressed. "At a time when so many families are struggling to pay for the basics, these tax credits have been a literal lifeline for millions of people to get healthcare they can afford."
"Voters just made it clear in the 2024 election that they want action to lower costs—and so it would be cruel to have the result be inaction that allows these tax credits to expire, and monthly healthcare costs to jump," he added. "For many millions of working Americans, premiums will double. For some, the spike will be not just hundreds but thousands of dollars of additional costs, leading many millions to lose coverage altogether. Congress must protect the health and financial security of our nation's families right now by extending these critical tax credits."
Citing several unnamed sources, The Washington Postreported Friday afternoon that Democrats on Capitol Hill privately proposed a deal to extend the ACA subsidies by a year, which "accompanied a broader package of healthcare proposals submitted to Republicans on Thursday night ahead of year-end spending negotiations."
"It is not yet clear whether Republican leaders, who control the House, will agree to any of the proposals," the Post noted. "Spokespeople for Republicans on the House Ways and Means and the Senate Finance committees declined to comment."
Despite efforts to salvage the ACA subsidies due to the pain and economic suffering that would follow if they are not extended, progressives across the board continue to argue that Obamacare—which sends billions of federal dollars to the private insurance industry—is a far inferior solution compared with Medicare for All, which would cover everyone in the United States at a lower overall cost than the current system.
"Childcare is a public good and needs robust federal investment to maintain progress that was made with relief funds and to avoid further crisis," reads an analysis.
With the last of the federal childcare funding included in coronavirus pandemic relief set to expire at the end of September, two civil society groups on Thursday released an analysis of the "significant benefits" the funding included for families and early childhood educators across the U.S.—showing that the federal government could, and "must," gain control of the nationwide childcare crisis with robust investments.
Published by the National Women's Law Center (NWLC) and the Center for Law and Social Policy (CLASP), Cliff Notes: Key Takeaways From Pandemic-Era Child Care Relief and the Child Care Funding Cliff analyzes the childcare benefits included in the American Rescue Plan Act (ARPA) of 2021, which provided $24 billion in childcare stabilization grants and $15 billion in supplemental money for the existing Child Care and Development Block Grant (CCDBG)—the latter of which is set to expire September 30.
The funding helped stabilize 220,000 childcare programs across the country, according to the report, assisting centers to pay staff members, rent, and continue providing services to families. A 2022 survey of childcare programs by the National Association for the Education of Young Children (NAEYC) showed that the funding also allowed 75% of respondents to pay employees sufficiently, with 53% providing bonuses and 38% increasing baseline wages in a notoriously low-paying industry.
When the childcare stabilization grants expired last September, Thursday's study found, it was felt across the country by families and childcare workers alike. Twenty-nine percent of families faced higher tuition due to rising operating costs for providers, and as employees told NAEYC in another survey in February 2024, staff shortages led to increased burnout among early childhood educators.
"Childcare is a public good and needs robust federal investment to maintain progress that was made with relief funds and to
avoid further crisis," reads a fact sheet accompanying the report by NWLC and CLASP.
The $15 billion in supplemental CCDBG funding set to expire at the end of the month allowed states to make "substantial improvements to their childcare assistance policies," which in turn eliminated waiting lists for childcare assistance, expanded eligibility for assistance, lowered or waived copayments for families, and increased payment rates to providers.
Now, said the groups, "the United States can and must make long-term investments in women, children, and families."
Melissa Boteach, vice president of childcare and income security at NWLC, said Congress must pass "$16 billion in emergency relief, alongside long-term investments, so that families and early educators can have the robust, fully funded childcare system that they need and deserve."
The report emphasizes that the U.S. government "has the resources to fulfill this vision," using as an example tax cuts for the wealthiest Americans that were included in former Republican President Donald Trump's 2017 Tax Cuts and Jobs Act.
"The soon-to-expire $15 billion ARPA supplemental CCDBG discretionary funding was a drop in the bucket compared to the amount of revenue lost from decades of tax cuts for the wealthy and large corporations," reads the report. "We can't afford to put off investing in early learning and childcare any longer, and we have an imminent opportunity to raise public dollars to support investments in childcare. In 2025, some provisions of the 2017 Tax Cuts and Jobs Act are scheduled to expire. If we allow the tax cuts for the wealthiest to expire and make additional progressive changes to the tax code, we could raise trillions of dollars in tax revenue that could support investments in women, children, and families."
Increasing the law's federal corporate tax rate from 21% to 28% would raise $1.35 trillion over 10 years, "which could fully fund President [Joe] Biden's childcare proposal twice over and still have money left over," reads the report.
The report makes clear, said Boteach, "that public investment in childcare works, and that our current childcare crisis is a policy choice."
The report was released as U.S. Rep. Ro Khanna (D-Calif.) prepared to introduce a bill that would cap childcare costs for families earning under $250,000 per year at $10 per day, modeled on a Canadian initiative. The proposal includes a grant program that would allocate $780 billion over 10 years to fund childcare providers.
"As a father of young kids, I understand how difficult this is for families," Khanna told Time magazine. "Particularly for those who are away from grandparents or uncles or aunts and are working or middle class. But I also think that it is fundamental to giving people a fair shot at the American dream—that the biggest investment we can make is in young children to have a big economic return."
Unless the federal government makes a "significant and sustained" investment in childcare, said Stephanie Schmidt, director of childcare and early education at CLASP, "the challenges and inequities plaguing the childcare sector will worsen and states will backslide on the progress they achieved using the relief funds to make care more affordable and easier to find."
Expanding the credit is a proven solution for lifting millions of children above the poverty line and helping to ensure that all children have the resources they need to thrive.
During the 2025 tax debate, policymakers have the opportunity to remake the tax code so that it is fairer, works for low- and moderate-income people and families, and advances racial equity.
A key priority should be expanding the Child Tax Credit to benefit the roughly 19 million children shut out from receiving the full credit simply because their families have low incomes. Lawmakers should, at a minimum, reinstate the successful 2021 American Rescue Plan expansion of the Child Tax Credit, including making the full credit available to children in families with low incomes and increasing the maximum amount of the credit to $3,600 for children aged five and younger and $3,000 for children aged 6 to 17, among other changes.
When the expanded credit expired, the number of children experiencing poverty rose substantially, demonstrating that child poverty is created—and can be alleviated —through policy choices.
There has been intensive congressional interest in the Child Tax Credit this year, including the House-passed bipartisan Wyden-Smith expansion, and proposals from congressional Child Tax Credit champions that build on the Rescue Plan.
Under current law, three major design flaws in the Child Tax Credit deny its full benefit to millions of children in low-income families:
The credit is also unavailable to 17-year-olds, who typically are still in high school.
An estimated 1 in 4 children—or roughly 19 million children—got less than the full $2,000-per-child credit or no credit in 2022 because their families’ incomes were too low. (See chart for examples of families at different income levels.) This includes nearly half of Black children, 4 in 10 Native American children, more than 1 in 3 Latino children, and about 1 in 3 children living in rural areas. Their families are overrepresented in low-paying work due to past and present hiring discrimination, inequities in educational and housing opportunities, and other sources of inequality. About 1 in 6 white children, more than 1 in 7 Asian children, and all children in Puerto Rico are also left out of the full credit.
When Congress temporarily expanded the Child Tax Credit in 2021, child poverty plummeted; the credit expansion reduced the number of children living below the poverty line by more than a third. While all racial and ethnic groups saw large reductions in poverty, the percentage point reduction in child poverty was largest for Black, Latino, and Native American children. In passing the American Rescue Plan, Congress extended the Child Tax Credit to all children living in families with low or no income for the first time, and increased the $2,000-per-child credit to $3,600 per child aged 5 and younger, and $3,000 per child aged 6 to 17 (making 17-year-olds eligible for the first time), among other changes.
When the expanded credit expired, the number of children experiencing poverty rose substantially, demonstrating that child poverty is created—and can be alleviated —through policy choices. A 2019 National Academies of Science, Engineering, and Medicine report on reducing child poverty found that “income poverty itself causes negative child outcomes.” A large number of studies have found evidence that additional income can improve children’s outcomes in the short and long term.
If the Rescue Plan version of the Child Tax Credit were in place for 2024, roughly 2.6 million fewer children would live in families with incomes below the poverty line. (See Table 1 at this link for estimates by state.) This includes 959,000 Latino children, 755,000 white children, 654,000 Black children, 79,000 Native American children, and 71,000 Asian children.
Congress should, at a minimum, reinstate the Rescue Plan expansion of the Child Tax Credit.
We’ve seen strong interest in the Child Tax Credit over the last year. Bipartisan tax legislation, which was negotiated by House Ways and Means Chair Jason Smith (R-Mo.) and Senate Finance Committee Chair Ron Wyden (D-Ore.), included a modest, but still important, expansion and passed the House with a large majority in January 2024. That proposal would have increased the Child Tax Credit for an estimated 16 million children in the first year, and lifted some 500,000 children above the poverty line when fully in effect.
Separately, two congressional proposals, Sens. Sherrod Brown (D-Ohio) and Michael Bennet’s (D-Colo.) Working Families Tax Relief Act and Rep. Rosa DeLauro’s (D-Conn.) American Family Act, build on the success of the Rescue Plan’s expanded Child Tax Credit. They make the full credit available to children in families with low incomes, propose larger maximum credit amounts than the Rescue Plan (by adjusting the Rescue Plan maximum credit amounts for inflation), and make additional changes to the credit. Though details differ, both proposals would lift more children above the poverty line over time than reinstating the 2021 Rescue Plan credit due to their larger maximum credit values and other changes. For example, according to a Columbia University analysis, had the American Family Act been in place for 2023 the credit expansion would have lifted an additional 3.6 million children out of poverty compared to current law.
Policymakers in both parties should make expanding the Child Tax Credit a priority in the 2025 tax debate. At minimum they should reinstate the Rescue Plan changes, which would provide an income boost to more than 60 million children in total, including the 19 million children in families with the lowest incomes. (See Table 2 at this link for estimates by state.) Expanding the Child Tax Credit is a proven solution for lifting millions of children above the poverty line and helping to ensure that all children have the resources they need to thrive.