The Affordable Care Act Subsidies Behind the Potential Government Shutdown — and What This Means for Women
President Trump and some members of Congress are pushing the country toward a government shutdown and astronomical increases in health care costs. The Affordable Care Act enhanced Premium Tax Credits (PTCs) that have reduced the cost of health insurance are set to expire at the end of the year. Without action by Congress right now, millions of people will lose their health coverage because of skyrocketing costs. Enhanced PTCs improve access to health care for women and children, who otherwise would lack the resources to afford the care they need.
What are enhanced ACA Premium Tax Credits?
PTCs, initially created as part of the Affordable Care Act (ACA), are subsidies that make health insurance on the ACA marketplaces affordable for millions of Americans. To give a sense of how crucial they are, 93% of ACA marketplace enrollees rely on these subsidies to afford their insurance. As part of our national response to the COVID-19 pandemic, these PTCs were enhanced under the 2021 American Rescue Plan Act (ARPA), making health care coverage affordable for more Americans, and the enhancements were extended under the Inflation Reduction Act through December 31, 2025. It is specifically because of these subsidies that millions of Americans have been able to pay for their health insurance plans, leading to a record number of individuals with health care coverage.
Why the enhanced PTCs are important to women and families
Last year, 11.2 million women enrolled in the ACA Marketplace and 10 million of these women received PTCs to afford health insurance. Low-income women, women of color, and non-citizen women are less likely to have health insurance, and health outcomes for uninsured women are demonstrably worse than those who have insurance. Uninsured women are less likely to utilize lifesaving preventive measures like mammograms, Pap tests, and timely blood pressure checks. Thanks to the enhanced PTCs, the rates of uninsured women and girls has remained low and ensured access to critical health care.
Moreover, people are also more likely to experience unexpected pregnancies when they are uninsured, which will only be compounded by the recent efforts to “defund” Planned Parenthood health centers and the broader abortion access crisis. When giving birth, patients with insurance are more likely to receive the prenatal care that best ensures a healthy pregnancy and delivery, and their children are less likely to have a low birth weight and unmet health needs. Providing affordable insurance options by extending the enhanced PTCs and supporting other pathways to affordable health care is the best way to increase the number of insured women.
What’s at stake if they expire
If enhanced PTCs expire before the end of the year, millions of women would lose their health care coverage due to massive increases in premiums. This would be devastating for women and their families both in terms of health outcomes and for household finances.
This shouldn’t be a partisan issue. If we look closely at who may be impacted, premium increases may have a disproportionate impact on people in southern red states, small business owners and employees, older adults, and rural Americans.
Millions seeking health insurance will find premium costs too high to afford, effectively barring them from coverage. Higher costs will rob roughly four million people of the health insurance they rely on. In 2024 alone, over 19 million people relied on enhanced premium tax credits, with the monthly benefit averaging $536.
The financial fallout would devastate communities. Health insurance protects women and their families from catastrophic care costs that often add up to thousands of dollars, contributing to the roughly $220 billion total medical debt in the United States. Overall decrease in coverage will lead to fewer paid bills, making it difficult for hospitals and providers to continue to provide care and lead to a $28 billion reduction in hospital spending over 10 years.
It doesn’t have to be this way. Congress has the opportunity to make permanent the enhanced PTCs, particularly in this moment. Enhanced PTCs are more than a bargaining chip; they are a lifeline for millions of women and families across the country. We urge Congress to make permanent enhanced PTCs as part of any funding bill.
