Behind the Numbers: The Real Americans who will be Hardest Hit if Congress Lets Premium Tax Credits Expire

Across the country, 22 million Americans use health care tax credits to afford their health care coverage. With costs for everything rising, from groceries to rent to health care, without the support of these tax credits as many as 4 million Americans could be priced out of health care they need. Many more will be forced to make impossible choices like whether to pay for health care coverage or put food on the table.

Behind every statistic is a real person or family. It could be the small business owners in Colorado buying their own health coverage, a filmmaker in Utah living with a disability, or the hairstylist in Pennsylvania whose job doesn't come with benefits. Each story reflects how these vitally important tax credits are in keeping health care within reach.

Real People, Real Stories

For Amy, who runs a small print publishing business in New Castle, Colorado, with her husband, that support was life changing. Her husband is covered by Medicare, but Amy relies on the marketplace. Utilizing enhanced premium tax credits, her monthly premiums dropped from a staggering $923 to just $1.57. That is right, just one dollar and fifty-seven cents gets Amy the coverage she needs to stay healthy.

Amy and her husband's household income is about $40,000, yet her medical needs alone could easily surpass that. She has hypermobile Ehlers-Danlos Syndrome, a relatively new diagnosis in the medical world, and the treatments can be costly. Premium tax credits allow Amy to stay healthy, keeping their small business open and contributing to the local economy.

Enhanced premium tax credits were extended by the Inflation Reduction Act (IRA) in 2022 with an expiration date set for the end of this year. That means, if Congress does not take action to extend the enhanced subsidies, when Amy, Stan and Christine enter the annual open enrollment period for health coverage on November 1, their premiums could skyrocket, with no guarantee that any tax credit relief will be available to them later.

Particularly worried about these increases is Stan in Salt Lake City, Utah, a filmmaker who has lived life in a wheelchair since a spinal injury in1996. Stan enrolled in marketplace coverage in 2012 after deciding to go into business for himself full-time. While that coverage is essential for Stan, maintaining his care is a strain on his wallet. "I knew that for me, being a person with a disability…I needed to be insured. I'm not a person who can't afford to not have health insurance."

For Stan, tax credits are what make his coverage affordable, with his current subsidies covering the entirety of his monthly premiums. If Congress allows those credits to expire, he said, "I'm actually looking at paying more than 50% of additional costs just for my premium. And we also know that with these health insurance plans, you're not just paying your premium but also the deductible goes up, the out-of-pocket costs go up. So, each year, it's becoming more and more costly, just in general, to have health insurance."

The expenses tied to Stan's disability highlight why affordable coverage is critical. "The biggest cost that I need is urinary. I have to buy catheters. I can't go to the bathroom without paying money." Out-of-pocket, the cost of catheters can reach about $1,440 every month. With insurance, it is still significant, ranging from $60 to $300, but without coverage the financial burden would be completely unmanageable.

Stan's story underscores how vital premium tax credits are for people with significant health care needs. But the struggle to afford coverage isn't limited to those living with disabilities or chronic conditions. For many working Americans with unpredictable or modest incomes, the loss of subsidies would be just as devastating.

Like Stan, Christine in Upper Chichester, Pennsylvania has an entirely unpredictable income, as she relies entirely on commissions. "Every week's different," she shared, "I can make $400 a week; I can make $800 a week." Her income places her just above the Medicaid eligibility threshold, putting her in a difficult position shared by many Americans, earning too much for public assistance but not enough to afford the basics, including health care.

Before these tax credits, Christine made the risky decision to go years without insurance. "Luckily, I was young enough that I didn't have any major problems. But now that I'm 51, I do." She lives with high blood pressure and a neck condition that may require surgery. Without coverage Christine could easily end up with medical debt.

The Consequences of Inaction

With the end-of-year deadline approaching and open enrollment just around the corner, 22 million Americans like Amy, Stan, and Christine are counting on Congress to permanently extend enhanced premium tax credits. Without action, many will be forced to delay, or even forgo, necessary care or take on crushing medical debt. The consequences will ripple far beyond individual households, creating catastrophic effects for families, communities and local economies.

This is why Families USA, Community Catalyst, and other national and state partners have come together in the fight to keep health care premiums affordable. It is past time for Congress to act, and Americans cannot afford to wait any longer - Congress must act NOW to permanently extend the enhanced premium tax credits. Learn more about how to hold Congress accountable and defend health care.