Enhanced Affordable Care Act (ACA) premium subsidies are set to expire at the end of 2025. These enhanced subsidies have been instrumental in increasing patient access to care. Without congressional action, millions of Americans could face steep increases in health insurance premiums or lose coverage altogether.
This issue was a key factor in the recent, prolonged government shutdown, which lasted a record 43 days. The shutdown ended only after Senate leadership committed to holding a vote on the future of the subsidies. As of November 25, discussions were underway about extending the enhanced subsidies or pursuing alternatives such as direct payments to consumers. However, no concrete plan is currently in place.
The ACA, signed into law in 2010, provides health coverage to roughly 40 million Americans. The ACA’s premium tax credits have helped families afford coverage, but the enhanced subsidies enacted under the American Rescue Plan Act and extended by the Inflation Reduction Act went even further, significantly lowering premium costs for low- and middle-income households. The enhanced subsidies reduced benchmark plan premiums to $0 for many people near the federal poverty level and sharply reduced required contributions for middle-income families.
If the enhanced subsidies expire, households would revert to higher contribution levels under the original ACA formula. For subsidized marketplace enrollees, this would mean an average premium increase of 114 percent, according to the Kaiser Family Foundation. Such drastic increases would force many Americans to forgo insurance entirely — a decision with serious and potentially life-threatening consequences. Without coverage, cancers are more likely to be diagnosed at later stages, when survival rates are lower and treatment is significantly more expensive. Premium spikes would also widen existing health disparities, particularly for low-income families and rural communities that already face barriers to high-quality care.
Ensuring that patients have access to affordable care requires bipartisan cooperation. AACI has designed a customizable letter template for cancer center members to use when contacting their congressional delegations. We urge you to write to your legislators and encourage them to protect access to health care, whether by extending the enhanced ACA premium subsidies or pursuing alternative measures that shield low-income individuals from unaffordable premium increases.