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- By Elyse Wild
As millions of Americans rang in the new year on January 1, Affordable Care Act (ACA) subsidies expired, passing on soaring premiums to the millions of Americans who purchase health coverage through the marketplace.
What are the subsidies?
The subsidies in question — Enhanced Premium Tax Credits (PTCs) — are a result of COVID-era legislation, the American Rescue Plan Act. The credits provided low to no-cost premiums for low- and middle-income families. In 2022, the PTCs were extended through 2025.
What happened?
Last fall, lawmakers fought over the subsidy extension, leading to the longest government shutdown in history. In December, Congress went on recess without passing legislation to extend the subsidies.
The expired credits have left policyholders facing premiums that are double — sometimes triple — their previous amount. The financial strain could force people to give up their plans.
What does that mean for Indian Country?
Access to healthcare has long been a barrier in Indian Country, in part driving high rates of chronic illness and the shortest lifespans of any demographic in the United States.
Native people access healthcare through an amalgamation of the Indian Health Service, tribal health services, Medicaid coverage, and ACA plans. According to the Urban Institute, 318,000 Native people were enrolled in ACA plans, and the Urban Institute estimates that 126,000 of those will lose their coverage without the tax credits.
The impact could extend beyond policyholders. The chronically underfunded IHS relies on third-party billing, generating $1.8 billion in 2023, significantly bridging the huge funding gaps that plague the agency.
Lawmakers are expected to come to an agreement in January or February 2026, potentially retroactively addressing the premium increases.
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