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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.
"The looting has begun," said one Democrat. "Far from unleashing record-breaking growth, the next Trump tax scam will make hardworking families worse off, shrink our economy, and blow a $4.6 trillion hole in the deficit."
The nonpartisan Congressional Budget Office projected Wednesday that extending provisions of the 2017 Trump-GOP tax law that are set to expire at the end of next year would shrink the U.S. economy over the long run, a finding that came as Republicans planned to move ahead with another round of regressive tax cuts within the first 100 days of the new Congress.
In its new analysis, the CBO found that allowing provisions of the 2017 Tax Cuts and Jobs Act to expire as scheduled in 2025 would have a positive long-term effect on Gross Domestic Product (GDP) growth compared to permanently extending the provisions.
"Expiration increases the long-term growth of potential GDP by about 6 basis points," the CBO said.
Sen. Sheldon Whitehouse (D-R.I.), chairman of the Senate Budget Committee, said in response to the CBO's findings that "the looting has begun."
"Far from unleashing record-breaking growth, the next Trump tax scam will make hardworking families worse off, shrink our economy, and blow a $4.6 trillion hole in the deficit," said Whitehouse. "What a racket, to push for trillions in tax cuts so billionaires keep paying lower rates than nurses and plumbers, and then cite deficit concerns to rob families needing things like home heating or childcare."
"Looting the treasury for megadonors is a rotten trick," the senator added, "and no amount of budgetary smoke and mirrors will hide it."
The CBO report was published as congressional Republicans continued to map out their legislative agenda before taking control of both chambers in January. The Associated Pressreported earlier this week that "in preparation for Trump's return, Republicans in Congress have been meeting privately for months and with the president-elect to go over proposals to extend and enhance those tax breaks, some of which would otherwise expire in 2025."
"It's always been about further enriching political and economic elites even at the cost of our economic future."
During the 2024 campaign, Trump pledged to sustain individual tax breaks enacted by the 2017 law—which disproportionately benefited the rich—and further reduce the statutory tax rate for U.S. corporations.
"The last time Republicans spent this much money for no apparent gain was the war in Iraq," Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, said Wednesday. "Trump's political donors want a return on their investment, and Republicans are going to give it to them, even at the cost of shrinking our economy and destroying jobs."
To offset the massive projected cost of extending the 2017 law and enacting new corporate tax cuts, Republicans are planning to pursue deep cuts to Medicaid, federal nutrition assistance, and other programs that help low-income Americans meet basic needs.
"President-elect Trump campaigned as a champion of the working class but his first act will be tanking the economy and throwing workers under the bus to line the pockets of his wealthy friends," said Lindsay Owens, executive director of the Groundwork Collaborative. "The Trump tax scam is back for its second act, and Americans should brace for impact."
David Kass, executive director of Americans for Tax Fairness, called the latest CBO analysis of the Republican Party's tax policies "even more damning than previous iterations."
"Using the country's credit card to give away trillions of dollars to the wealthiest Americans and big corporations would be disastrous for our economy and the average American," Kass said Wednesday. "The Trump Tax Scam bill has never been about economic growth or improving the lives of working and middle-class Americans. It's always been about further enriching political and economic elites even at the cost of our economic future."
"Moving forward," Kass added, "the incoming administration and congressional Republicans must answer why they plan to make hardworking Americans worse off, shrink our economy, and increase the deficit by $4.6 trillion."
"This report should add urgency in Congress as the Trump tax scam expires next year and we negotiate future tax legislation," said Senate Budget Committee Chair Sheldon Whitehouse.
As a Capitol Hill battle over the "GOP tax scam" looms, U.S. Senate Budget Committee Chair Sheldon Whitehouse on Wednesday pointed to a new nonpartisan government analysis about soaring wealth inequality as proof of the need for serious reforms.
Whitehouse (D-R.I.) sought the Congressional Budget Office (CBO) report, which details trends in the distribution of family wealth—including projected Social Security retirement and disability benefits—in the United States from 1989 to 2022.
"Adjusted for inflation, the wealth held by families in the United States almost quadrupled between 1989 and 2022, rising from $52 trillion (in 2022 dollars) to $199 trillion, at an average rate of about 4% per year," the CBO found. "Over that 33-year period, family wealth was unevenly distributed, and that inequality increased."
"In 2022, families in the top 10% of the distribution held 60% of all wealth, up from 56% in 1989, and families in the top 1% of the distribution held 27%, up from 23% in 1989," the office said. "The share of wealth held by the rest of the families in the top half of the distribution shrank from 37% to 33% over the same period. Families in the bottom half of the distribution held 6% of all wealth in both 1989 and 2022."
"By making the wealthy pay their fair share, we can protect Social Security forever and unrig our tax code."
The report comes as Congress prepares for a tax debate due to next year's expiration of policies signed into law in 2017 by then-President Donald Trump, the Republican facing Democratic Vice President Kamala Harris in this November's election.
Throughout the current election cycle, Trump and congressional Republicans have campaigned on extending policies from the Tax Cuts and Jobs Act, which slashed the corporate tax rate from 35% to 21% and also benefited wealthy individuals.
"This report should add urgency in Congress as the Trump tax scam expires next year and we negotiate future tax legislation," Whitehouse said of the CBO analysis. "Do we want to reward billionaires, who have already captured so much of the nation's wealth, or do we want to de-corrupt the tax code, ensure the wealthy and big corporations pay their fair share, and reduce the deficit, all while making necessary investments to better the lives of all Americans?"
Whitehouse noted that the report also comes amid concerns about the future of Social Security. Citing the CBO analysis, his office detailed:
"Social Security is a bedrock of our retirement system and ensures millions of seniors can retire with dignity," Whitehouse said. "Seniors earned their benefits throughout their working lives, but the program is now facing a looming cash flow problem. By making the wealthy pay their fair share, we can protect Social Security forever and unrig our tax code—exactly what my Medicare and Social Security Fair Share Act would do."
Whitehouse's bill is spearheaded in the lower chamber by U.S. House Budget Committee Ranking Member Brendan Boyle (D-Pa.), who also recently requested a CBO report. That one focuses on the impact of raising the full retirement age for Social Security from 67 to 69, as various Republican groups have proposed.
The CBO's Social Security analysis, released last week, found that for workers now in their 30s and 40s, the average annual benefit cut would be around $3,500 a year—and the GOP's proposed changes wouldn't even extend the program's solvency.
"This independent, nonpartisan report shows just how devastating Republican plans to rip away hard-earned Social Security benefits would be for American workers," Boyle said last week. "Instead of saving Social Security by making the ultrarich pay their fair share, the GOP is hell-bent on gutting benefits for the middle class."