Millions of working Americans could face losing their health insurance soon if the Trump administration and Congress do not act. Small businesses and middle-income earners are likely to be hit the hardest. Interestingly, many of these individuals live in districts represented by Republican lawmakers.
A recent report from the Treasury Department shows that around 4.7 million small business owners and self-employed workers have relied on the Affordable Care Act (ACA) Marketplace for health insurance this year. However, the tax credits that help lower their insurance costs are set to expire at the end of December. The lack of action from the Trump administration and Congress could lead to a healthcare crisis for many.
Back in 2021, Congress raised the income limits for these tax credits, encouraged by President Joe Biden. The Inflation Reduction Act kept these subsidies alive until 2025, making health insurance more accessible. As a result, enrollment in the ACA reached a record high in 2024. Still, many people don’t even realize these subsidies exist. According to a poll by KFF, half of the beneficiaries are unaware that their health insurance is partly funded by federal dollars.
Some surprising demographics are also affected. A significant portion of ACA enrollees, about 56%, live in Republican districts, and 76% are from states Trump won in the 2024 election.
If these credits disappear, states could lose $34 billion in GDP, as well as around 286,000 jobs mainly in healthcare facilities. A report from the Commonwealth Fund emphasizes that out-of-pocket costs could rise dramatically, with average premiums increasing by over 75%. Middle-income families might lose up to $5,370 a year in subsidies, forcing many to forgo insurance altogether.
Mary Mayhew, CEO of the Florida Hospital Association, points out the urgency. “We will see our uninsured rates increase significantly for individuals who are largely working,” she stated. Mayhew, who previously opposed the ACA, now advocates for extending these subsidies due to the challenges small businesses face.
Experts like Leighton Ku from George Washington University note that since launching in 2014, the ACA has halved the number of uninsured people. The flexibility it offers has allowed businesses to hire part-time employees and has given entrepreneurs and young adults better access to health coverage.
Mayhew urges Congress to put aside political differences and recognize the importance of these programs for small businesses. “This is working,” she argues.
The stakes are high. If Republicans don’t take action to extend these subsidies, they might be giving Democrats an election season gift. This developing situation could change the healthcare landscape for millions of Americans.
For more insights, you can explore KFF’s reports on health policy here.
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