Time is running out for millions of Americans who could experience higher health care costs or lose their health insurance entirely. At the end of this year, Affordable Care Act Premium Tax Credits (APTCs) are set to expire. The expiration of these tax credits would hike health care costs for more than 24 million Americans who purchase their own health insurance coverage in the exchange marketplaces and threaten an estimated five million working-class Americans with the prospect of losing their coverage.
These credits are a lifeline, helping working Americans, often small business owners or employees who do not get health care benefits through their employer, and their families, afford health insurance in the face of rising costs. Without Congressional action, that lifeline will be cut, and millions of Americans who purchase their own health insurance will face a devastating health care tax hike. The consequences will be most severe for those working and living on the financial edge—people who work hard, often in low-wage jobs, and rely on access to affordable basic health care for themselves and their families, made possible by APTCs.
This is more than a budget issue; it’s a looming affordability and health care crisis. Over the past four years, Americans have faced relentless cost increases just to cover basic needs. According to an analysis by Bankrate, since the pandemic, consumer prices have been up 24%. Failing to extend the APTCs means nearly 20 million working Americans will see their health care premiums skyrocket.
The numbers are stark. According to a study from Keep Americans Covered, a national coalition representing patients, hospitals, health insurers, and employers, a family of four earning $64,300 would see their premiums jump by 93% in 2026. Five million people would lose coverage, with a disproportionate number living in rural areas, who would lose all enhanced subsidies and be forced to pay the full cost of coverage.
As costs rise for products and services, millions of Americans would be forced to forgo insurance altogether. When illness strikes, many will have no choice but to seek care in emergency departments—often for conditions that could have been treated earlier and more affordably by a primary care provider. Because emergency rooms are legally required to treat everyone, regardless of ability to pay, they have become the de facto safety net for our entire system. This is the most expensive and inefficient way to deliver care. It places immense strain on already overburdened hospitals—particularly those in rural and low-income communities—resulting in longer wait times and fewer resources for patients who truly need emergency treatment.
The result? A sharp spike in uncompensated care and an additional financial blow to a health care system already operating under tremendous strain, especially for providers serving rural and underserved communities.
Operating margins for many non-profit and safety net hospitals remain dangerously thin. Labor shortages have pushed staffing costs higher, inflation is driving up the price of supplies and pharmaceuticals, and government reimbursements don’t keep pace with the actual cost of care. Rural and urban safety-net hospitals are especially vulnerable, with more than 600 rural hospitals at risk of closure, according to the Chartis Center for Rural Health.
The health care system also already faces substantial uncertainty as the impact of other recently adopted major policy changes has yet to be felt or absorbed. The expiration of APTCs would not only hike patient costs and increase the number of uninsured Americans — but could also destabilize an already fragile health care system, especially in the current moment of elevated uncertainty. The result could be reduced access, diminished services, and overwhelmed hospitals.
Every day, more than one in seven patients receives care in a Catholic hospital. For us, health care is not a luxury or a privilege reserved for those who can afford it; it is a fundamental human right grounded in the inherent dignity of every person. When a family loses access to health coverage, it’s not just their finances that suffer—it’s their health, stability, and dignity as well. Catholic health care ministries remain steadfast in their commitment to providing compassionate, whole-person care to everyone who walks through our doors.
Extending APTCs is not just a smart policy—it is a fundamental obligation to ensure that every family can afford the health care they need. Doing so will protect access to care for low—and middle-income families, older adults, and rural communities. Congress must act now to extend the APTCs and prevent a crisis in coverage. Failure to do so would deliver a devastating blow to millions of working families and individuals and to the providers who care for them. At stake is not just the stability of our health care system, but the health and dignity of the people we serve.
Sr. Mary Haddad, RSM, is President & CEO of the Catholic Health Care Association of the United States.
