New Hampshire Senator Jeanne Shaheen added her voice to the chorus of Democrats, some Republicans and numerous experts sounding the alarm about the consequences of letting the Affordable Care Act (ACA) enhanced premium tax credits expire at the end of this year.
The senator appeared on CNBC’s Squawk Box recently to explain how not extending the tax credits could prove a health care catastrophe for millions of Americans (1).
“Failure to extend those tax credits,” she warned, “is going to see insurance costs rise for over 20 million people and about 4 million people lose their health insurance entirely.”
And she’s not wrong. A letter (2) from the Congressional Budget Office (CBO) back in May outlined the effects of not renewing the tax credits — which are largely used by lower- and middle-income Americans who earn approximately $15,000 to $60,000 annually, or between 100% and 400% of the federal poverty level (FPL).
The CBO letter explained that “the expiration of the expanded premium tax credits will increase the number of people without health insurance by 4.2 million in 2034.”
Meanwhile, early this year it was reported that ACA enrollment hit an all-time high of 24 million Americans (3) — most of whom would see their health care premiums skyrocket if the enhanced credits end.
Originally introduced in 2021 and renewed the following year, the ACA enhanced premium tax credits are at the heart of the ongoing government shutdown. Democrats demanded Republicans extend them in exchange for their votes to keep the government open, but Republicans refused and remain split (4) on whether they want to continue them at all.
Democrats wanted the tax credits extended not just before they expire on Dec. 31, 2025, but ahead of the beginning of open enrollment on Nov. 1. Otherwise, the CBO explained (5), it would reduce the likelihood that 2026 premium costs would reflect the tax credit discount.
Shaheen said that extending the tax credits “is in everybody’s interest,” adding that data show that “if we don’t extend these tax credits, the GOP is going to pay at the polls next year.”
The Kaiser Family Foundation (KFF) found in a recent survey that 78% of Americans want the tax credits extended, including 59% of Republicans (6). If getting 78% of Americans to agree on anything these days isn’t impressive enough, another 76% said that they’d either blame President Donald Trump or congressional Republicans if the tax credits end.
And that blame is likely to come fast and fierce. That’s because estimates for the rise in health care premiums without the tax credits range from an average increase of 114%, or an added $1,016 annually (7), up to a possible 400% increase, going from $180 to $905 annually for people whose incomes fall between 150% and 200% of the FPL (8).
Meanwhile, older Americans and those who live in rural areas could be hit especially hard by a loss of the ACA tax credits.
The Center for American Progress found that those over age 55 could see premium increases as much as $16,700 annually (9), while The Century Foundation think tank reported that rural county Americans would face a premium increase of 107% compared to urban county residents, who’d pay 89% more (10). And that, they added, is on top of an overall national median 18% increase in premium costs as of August 2025.
If the tax credits are allowed to expire, KFF found that 37% of Americans would keep their insurance and pay the higher costs, while 22% would look elsewhere for new coverage. Another 42%, however, said that they’d likely go without insurance altogether (6).
Read more: 30% of US drivers switched car insurance in the last five years. Here’s how much they saved — and how you can cut your own bills ASAP
Health policy analyst Louise Norris recently spoke with CBS News about the possible end of ACA enhanced premium tax credits (11). Her advice for those who rely on them is short and sweet: don’t panic, but prepare.
“Being proactive will help minimize financial surprises,” she said.
Here are three ways you can be proactive about your health coverage today.
From employer plans (if your workplace offers one) to Medicaid coverage (if you qualify), it’s wise to start shopping around for ACA alternatives. HealthCare.gov is a good place to start, with resources to help you compare plans that suit your needs and health insurance navigators who can answer your questions.
If you haven’t already started putting money away for health care needs, now would be a good time to begin. Having any sort of emergency savings will help soften the blow if the ACA tax credits end and you find yourself in a lower-tier plan or, worse, without a plan altogether. Pairing a health savings account with a high deductible plan is a solid strategy if you believe you’ll stay relatively healthy, as premiums are lower and you can bank and grow savings to be used if a health care emergency arises.
Get caught up on physical checkups, immunizations, prescriptions, specialist visits, counseling or anything else that your plan currently covers — and stay up to date through to the end of the year — while you still have your existing plan. If the tax credits do expire and you’re forced to find alternative health insurance, it’ll be one less thing to worry about knowing that you’ve addressed your health care needs as much as possible in the interim.
Join 200,000+ readers and get Moneywise’s best stories and exclusive interviews first — clear insights curated and delivered weekly. Subscribe now.
We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines.
CNBC (1); Congressional Budget Office (2); The Associated Press (3); Politico (4); Congressional Budget Office (5); Kaiser Family Foundation (6); Kaiser Family Foundation (7); Urban Institute (8); Center for American Progress (9); The Century Foundation (10); CBS News (11)
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
