The clock has run out for folks hoping Congress will help make their Marketplace health insurance more affordable.
Even though a small number of Republicans in the US House recently joined Democrats to support a discharge petition to force a vote on extending the enhanced premium tax credits (none from AZ including Ciscomani), it came too late to matter for next year.
Speaker Mike Johnson has refused to bring the bill to the floor, and under House rules, any vote wouldn’t happen until January.
Health plans that start January 1, 2026 are already priced and no longer include the former enhanced advance premium tax credits.
Even if the House acts in January, it’s doubtful the Senate would follow. The practical result is straightforward: the enhanced premium tax credits are almost certainly gone.
As a result, Marketplace premiums will rise a lot for most of the 350,000 or so Arizonans who buy Marketplace health insurance.
Those former enhanced subsidies mainly helped people earning between 138% and 400% of the federal poverty level, working adults who don’t qualify for Medicaid and don’t get insurance through a job.
The impact will be different depending on how much the person or family makes.
- People closer to 138% of poverty will see the largest percentage increases in premiums.
- People between 300% and 400% of poverty will face large dollar increases — often hundreds of dollars more per month.
Folks will now be making various choices depending on their values and family circumstances. I can think of 4 different ways this will affect Marketplace customers:
- They’ll drop coverage altogether, gambling that they won’t get sick or injured. Healthier and younger people will disproportionately choose this option – further damaging the risk pool and making premiums go up in the long run.
- They’ll downgrade plans, moving from Gold or Silver to Bronze plans with lower premiums but sky-high deductibles.
- They’ll pay more and cut back elsewhere, staying in the same plan category but sacrificing other household needs.
- They’ll change jobs for insurance, giving up freelance work or small businesses to find employer-sponsored coverage.
The former enhanced premium tax credits have worked exactly as intended. KFF data show they helped drive record marketplace enrollment and made coverage affordable for middle-income families who were previously priced out.
This was a policy choice. Congress has chosen higher premiums, fewer insured people, a weakening of the risk pool leading to higher long term premiums, more medical debt and uncompensated emergency department care.
Remember that in November.
