Read more from @centeronbudget.bsky.social about why HSAs and other proposals won’t make coverage more affordable and do little to help the people who would hurt the most from expiring premium tax credit enhancements.

If Congress doesn’t act and PTC enhancements expire, enrollees with the lowest incomes will lose access to $0-premium plans and face affordability challenges and burdensome red tape that will result in substantial coverage losses.

PTC enhancements made coverage affordable for many in states that haven’t expanded #Medicaid. While the uninsured rate fell nationwide after the enhancements, low-income people in nonexpansion states saw the greatest declines because their counterparts in expansion states had access to Medicaid.

Losing $0 premium plans will hit hard in states that did not expand #Medicaid under the #ACA. In these states, people w/ incomes 100-138% FPL ($15,650-$21,597 for an individual) would lose access to no-premium plans—even though they would be eligible for Medicaid if they lived in an expansion state.

Losing access to plans with $0 premiums makes people with low incomes more likely to lose coverage. Beyond affordability, administrative burdens and confusion prevent people from paying even small premium amounts.

Without PTC enhancements, enrollees with the lowest incomes would face monthly premiums for benchmark silver plans. Even small costs can force them to choose between having health coverage and affording necessities like food and housing.

The megabill and reg will make marketplace coverage less affordable for enrollees, more difficult to enroll and stay enrolled, and increase the number of people who are uninsured. If Congress takes away PTC enhancements, millions will be unable to get and keep affordable marketplace coverage.

The marketplace reg and megabill block many people with lawful immigration statuses from accessing affordable marketplace coverage. Already, people with DACA are no longer able to enroll in marketplace plans or receive PTCs and even more immigrants will lose access in 2026 and beyond.

The reconciliation megabill and the Trump admin’s marketplace rule make enrollment, eligibility, and affordability even harder. This year’s open enrollment will be especially confusing—and the admin cut Navigator funding by 90%, meaning there’s less support for enrollees to navigate the red tape.

Trump admin policies are contributing to higher underlying premiums—increasing by a median of 18% for 2026. Enhanced PTCs insulate most enrollees from dramatic increases in costs, but without enhancements enrollees may have to pay impossibly high premiums.

PTC enhancements have been a lifeline for enrollees with low to moderate incomes, who will face the greatest harm if Congress allows these enhancements to expire at the end of this year and could lose affordable coverage.