American Healthcare Progress in Jeopardy
Today, only 8% of Americans lack health insurance – a remarkable improvement from when one in five Americans had no coverage. This dramatic reduction didn’t happen by chance but through deliberate policy efforts that now face serious threats.
The significant expansion of healthcare access has been driven by two key programs: the federal and state insurance marketplaces with enhanced premium tax credits, and Medicaid expansion. Together, these initiatives have created a safety net that has improved health outcomes and financial security for millions of American families. However, looming policy changes threaten to unravel these gains and potentially push millions back into the ranks of the uninsured.
Record-Breaking Marketplace Enrollment
The federal and state insurance marketplaces serve as comprehensive online platforms where individuals can compare and purchase health coverage independently. These marketplaces offer premium tax credits designed to reduce monthly individual and family premium payments to more affordable levels for those with low and moderate incomes.
In 2021, new legislation dramatically improved coverage affordability by implementing enhanced premium tax credits. The following year, these enhanced credits received an extension through 2025. This increased affordability directly contributed to unprecedented marketplace participation, with 24.2 million consumers enrolling in coverage through federal and state marketplaces in 2024 – an all-time record.
The enhanced tax credits have made a substantial financial difference for American families. The average marketplace enrollee saved approximately $700 in 2024 due to these enhanced premium tax credits. This financial relief has been crucial for maintaining consistent coverage and reducing the financial burden of healthcare costs on household budgets.
Medicaid Expansion’s Critical Role
While marketplace enrollment has surged, Medicaid expansion has simultaneously covered millions more Americans. This joint state-federal program has provided essential care access for people with low incomes and people with disabilities for over six decades.
Since 2013, many states have expanded Medicaid eligibility with increased federal matching funds. Today, the program provides coverage for more than 70 million Americans nationwide. The impact has been transformative – Medicaid expansion has cut the rate of non-elderly uninsured adults by more than half while simultaneously improving health outcomes and reducing mortality rates.
The expansion has particularly benefited vulnerable populations who previously fell through coverage gaps. Over 13 million additional Americans have gained coverage through Medicaid expansion since 2013, representing one of the most significant healthcare access improvements in recent American history.
Flexible Coverage Options for Life Transitions
Both enhanced premium tax credits and Medicaid provide crucial flexibility during major life transitions. Together, these programs have helped previously insured individuals maintain their coverage through employment changes and other life events.
For example, a person seeking employment might initially enroll in Medicaid. After securing a job that doesn’t offer employer-sponsored health insurance, that same individual can transition to marketplace coverage with premium tax credits making it affordable. This seamless coverage continuum ensures Americans don’t face dangerous gaps in health insurance during periods of transition.
Millions of Americans at Risk
Despite these achievements, the United States now faces the stark possibility that years of healthcare access progress could be reversed through policy changes under consideration.
Current policy discussions include potential cuts to Medicaid funding that could result in millions losing program eligibility. While some affected individuals might attempt to transition to marketplace coverage, this safety net is also under threat. Unless Congress takes action to extend the enhanced premium tax credits beyond their 2025 expiration date, marketplace coverage will become significantly less affordable.
The consequences would be severe. According to Congressional Budget Office estimates, the number of uninsured Americans would increase by 2.2 million in 2026 without an extension of enhanced tax credits. By 2027, this number could grow to 3.7 million additional uninsured Americans.
Either change – allowing enhanced premium tax credits to expire or altering Medicaid funding and eligibility – would create substantial barriers to affordable coverage. Combined, these changes would generate widespread financial hardship and make coverage unattainable for millions of Americans.
Health Consequences of Coverage Losses
The health implications of coverage losses extend beyond financial concerns. People without insurance coverage frequently delay or entirely skip necessary medical care, leading to worse health outcomes across numerous conditions. For individuals with chronic illnesses or in poor health, the results can be particularly dangerous or even life-threatening.
Preventive care often becomes a casualty when insurance coverage is lost. Conditions that could be managed effectively with early intervention instead progress to more serious stages requiring intensive and expensive treatments. The human cost of these coverage reductions would be measured not just in financial terms but in avoidable suffering and potentially shortened lives.
Healthcare System Distress
Beyond individual impacts, the healthcare system itself would face significant strain. The expiration of enhanced premium tax credits would trigger a $6.3 billion increase in uncompensated care – medical services provided without payment – due to the growing number of uninsured individuals unable to afford out-of-pocket expenses.
Some proposed Medicaid changes could drive uncompensated care even higher, potentially increasing it by $19 billion. Hospitals absorb the majority of these costs, ultimately leading to reduced services, higher prices for those who can pay, and diminished community investments.
This financial pressure comes at a particularly vulnerable time when many hospitals already face closure risks due to financial constraints. Rural and safety-net hospitals serving vulnerable populations would be disproportionately affected, potentially creating healthcare deserts in communities that need services most.
Economic Consequences Beyond Healthcare
The economic impacts would extend well beyond the healthcare sector. If Medicaid funding reductions coincide with premium tax credit expirations, state and local economies would experience substantial damage as coverage losses mount and the healthcare sector sheds jobs.
Uninsured Americans facing urgent medical needs often exhaust their limited financial resources, creating ripple effects throughout local economies. Healthcare providers would reduce staffing and spending in response to financial pressures, triggering broader employment consequences.
Analysis shows that enhanced premium tax credit expiration alone would result in a $34 billion reduction in gross domestic product and approximately 286,000 job losses nationwide. Nearly half these job losses would occur in hospitals, physician practices, and pharmacies.
States that have not expanded Medicaid would experience disproportionate economic harm if enhanced premium tax credits expire, as these states lack alternative affordable coverage options. The ten non-expansion states – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – would bear the brunt of job losses, accounting for 194,000 of the 286,000 total job losses.
Commitment to Universal Affordable Coverage
Healthcare organizations like Kaiser Permanente maintain that everyone deserves access to high-quality, affordable healthcare through an effective mix of public and private coverage options. As part of its community commitment, Kaiser Permanente currently serves 1.5 million Medicaid beneficiaries and over 800,000 marketplace enrollees.
To protect American families, preserve healthcare system stability, and support economic health, Congress must extend the enhanced premium tax credits while maintaining current federal Medicaid funding levels and continued coverage for low-income adults.
The Path Forward
As policymakers navigate budget decisions and competing priorities, preserving successful healthcare access programs should remain paramount. The progress achieved in reducing uninsured rates represents a significant public health achievement that directly improves millions of lives.
Rather than undermining these effective programs, lawmakers should focus on building upon their success while finding budget savings in areas that don’t jeopardize healthcare access. The alternative – allowing coverage losses to mount – would harm individuals, communities, healthcare systems, and the broader economy for years to come.
The choice ahead is clear: continue supporting policies that have demonstrably expanded healthcare access and improved lives, or accept the serious consequences of coverage reductions for millions of Americans. The health and financial security of the nation depend on making the right decision.
