At the end of this year, unless Congress acts, special tax credits that in recent years have allowed more people to be able to afford coverage by the ACA, will expire – and the consequences will be swift and devastating for our entire country. The damage to people’s health care and the economy will ripple across every state and region. More than 4 million Americans – old and young, urban and rural, blue-collar and middle-class – will lose their coverage.
As the governor of Hawaii and a physician, I see every day just how vital health insurance is to people. Reliable coverage is a lifeline that means better health outcomes, more economically secure families and healthier communities. These subsidies are at the center of the now record-long federal government shutdown. If Congress doesn’t act to extend these precious ACA subsidies, which were first established in 2021, we will see that lifeline slip away from millions of Americans of every age and income level. It is important that we fight to protect them now.
I treated patients in the emergency room for more than 20 years before I was elected governor. I saw firsthand too many people who came into the ER with life-threatening conditions that could have been prevented with regular checkups – but they couldn’t afford insurance so they just didn’t go to the doctor until it was an emergency.
When people lose insurance, they don’t just lose peace of mind. They stop going to the doctor, they delay treatment and they ignore health issues that can turn into bigger problems that require more expensive care. A lack of coverage results in poorer health outcomes and catastrophic costs for families already under pressure, often leading to bankruptcy.
If these ACA subsidies end, the average premium payments for people enrolled on the national insurance exchanges will rise by more than 75%, while some state premiums will more than double. Even people who can afford to keep their coverage will have to pay more. That means more financial stress, fewer prescriptions filled and more preventable health emergencies.
The Strain On Our Health System
If the ACA subsidies vanish, our health care infrastructure will suffer as well. Providers nationwide will lose more than $32 billion in revenue in 2026 alone, while uncompensated care could spike by $7.7 billion. That means potential hospital closures, strained ERs and underfunded clinics, especially in rural and underserved communities.
And it gets worse. When healthy individuals drop coverage because they can’t afford it, premiums rise for everyone else. It’s a dangerous spiral that threatens to hurt us all.
If the subsidies expire nationwide, one study estimates that state economies will shrink by about $40.7 billion, and roughly 339,000 jobs will be lost in 2026 alone. That means fewer jobs in health care and adjacent sectors, and more pressure on overstretched caregivers and small business owners.
Lost jobs mean less income, less tax revenue, and less ability for local hospitals and clinics to operate. Access to care will decrease everywhere, for individuals and for the system. Entire communities will suffer.
Many States, One National Crisis
Here’s a snapshot of what will happen next year in states across the country if the ACA’s enhanced premium tax credits are allowed to end:
- California: Average insurance premiums will rise by 66% for about 1.7 million people, and more than 20,000 jobs will be lost.
- Florida: Average premiums could increase by as much as 114% for 4.7 million people, and over 57,000 jobs will be lost.
- Georgia: Average premiums will rise over 75% for more than 450,000 people, 340,000 people will become uninsured – increasing that population by 27% – and more than 33,000 jobs will be lost.
- Kentucky: Average premiums will increase by more than 37% for about 100,000 people.
- Maryland: Premiums will increase as much as 154% for 180,000 people, and as many as 33,000 will lose coverage.
- New Jersey: Average premiums will increase by 175% for over 450,000 people.
- Texas: Premiums will rise for more than 4 million people causing 800,000 to lose coverage, and over 83,000 jobs will disappear.
In all these states, working-age adults and those nearing retirement age will be hurt by a totally preventable disaster. In the 10 states that did not expand Medicaid under the ACA, the damage will be even worse, because the ACA marketplace is the only affordable option many residents have there. Those 10 states alone will lose approximately a quarter of a million jobs.