Washintonians and people nationwide rely on financial assistance in order to access health care.
In the nation’s capital, where more than 11,900 residents enrolled in marketplace health insurance plans in 2024, the fight over extending Affordable Care Act (ACA) tax credits is hitting home.
Although only 2.7% of the city’s population is uninsured—far below the national rate of 8%— many residents still rely on financial assistance to keep their health coverage. Roughly 22% of D.C. enrollees received advance premium tax credits, now at risk of expiring at the end of the year.
Across the country, more than 20 million people rely on ACA marketplace plans, and 93% receive premium tax credit assistance, according to the Kaiser Family Foundation. Those credits were first expanded under the American Rescue Plan Act in 2021 and extended through 2025 by the Inflation Reduction Act.
However, Congress is now debating whether to continue the funding and millions face the threat of steep increases in monthly premiums.
“Last week, House Republicans passed a disastrous tax package that puts Medicaid at risk… and raises premiums for folks with ACA coverage,” Rep. Nikki Budzinksi (D-Ill.) wrote on X, formerly known as Twitter. “I’m going to keep fighting against this scheme to make health care LESS accessible and MORE expensive.”
Republican lawmakers are facing mounting pressure—from constituents, health care advocates, and even their own colleagues—to preserve the tax credits. But many remain hesitant, fearing political consequences from former President Donald Trump, who continues to push for a full repeal of the ACA.
Keep Americans Covered (KAC), a coalition of patient advocates, doctors, insurers, and health care providers, has launched a national seven-figure ad campaign calling on Congress to extend the credits. One of the most striking ads features Jessica, a restaurant manager in Arizona and cancer survivor, who depends on the credits to pay for her 10-year-old daughter’s diabetes care.
“We were living a perfectly normal life, and we suddenly had a child that had a chronic illness,” Jessica says in the ad. “We’re not wealthy. Money can get tight… we need Congress to take action now. It’s vital for us. We need these healthcare tax credits passed today.”
If Congress fails to act, the consequences will be swift and severe.
In Arizona, a family of four earning $64,000 would see a 493% increase in annual premiums—an extra $2,571 out of pocket. In Florida, a 60-year-old couple could pay $19,000 more per year. Nationally, the impact would be felt by small business owners, independent contractors, gig workers, and families with no access to employer-sponsored plans.
A new KAC-backed survey found overwhelming bipartisan support for extending the tax credit, with 72% of voters in favor—including 63% of Republicans. In battleground districts, 70% of voters say the issue is important to them, and nearly half said they would be less likely to support lawmakers who oppose the extension.
Still, deep divisions remain in Congress. Sen. Thom Tillis (R-N.C.) has signaled support for a bipartisan solution, citing the need for stability and affordability in health care.
“We should start thinking about a stream of bipartisan bills that we can work on,” Tillis said.
However, other Republicans, like Sen. Mike Rounds (R-S.D.), are echoing Trump’s critiques of the ACA, claiming the credits have added to the national deficit.
“There’s been a facade out there about the entire program actually paying for itself,” Rounds said.
With the Senate preparing to take up the tax package passed by the House, time is running out. Premiums for 2026 are already being set. If the credits are allowed to expire, families may be forced to choose between rent and health insurance or go without care altogether.
Keep Americans Covered has warned that as many as 5 million people could lose their coverage entirely if the tax credits are not extended.
“The Senate and President Trump still have time to prevent this crisis,” the coalition said in a recent statement. “But not much. They must act quickly to protect the marketplace, extend the health care tax credit, and support working people in America.”
