Commentary: ACA tax credits helped more Oregonians find coverage. Will Congress keep them?

The decision before Congress is simple: protect families and communities by extending the healthcare tax credits that keep millions insured

This year, more than 97% of Oregonians had health insurance. Getting to this level of coverage took years of steady effort and happened because our state treats health coverage as essential for keeping people healthy, for helping families avoid medical debt and for holding down costs for everyone.

For tens of thousands of small business owners, older Oregonians not yet eligible for Medicare, and working families, health insurance has been affordable because of Affordable Care Act tax credits.

This week, Congress will vote on whether to continue these ACA tax credits or let them die, putting years of hard-won progress at risk of unraveling overnight.

If Congress terminates the healthcare tax credits, 4.8 million Americans will lose their coverage immediately, and insurance premiums could more than double for 20 million others. Some families will see their annual costs rise by more than $8,000.

Every Oregon member of Congress must vote to extend these health care tax credits without delay.

The stakes could not be more clear. If the health care tax credits are terminated, researchers estimate 8,800 Americans will die every year as a result. Put another way: this holiday season, Congress will decide if 24 American sons, daughters and parents live or die for each of the 365 days in 2026 and years beyond.

We in medicine who provide health care will be the first to see the results of Congressional action or inaction. Health care needs don't go away if people don't have insurance coverage — people just come to us for help when they're sicker. Then, treatment is more intensive, more expensive and too often too late.

The financial implications are stark as well. If Congress terminates the tax credits, everyone —not just those who get credits now — will pay much more for their health care in the New Year and beyond. Oregon families are already struggling with rising prices for housing, groceries and childcare.

The last thing we can afford is higher health care costs because Congress chose to terminate assistance that has kept health insurance within reach.This year there are more than 139,000 Oregonians in the ACA insurance marketplace including almost 31,000 in rural Oregon.

If Congress ends the ACA tax credits, more than 35,000 Oregonians will lose all financial assistance for health insurance starting next month. This comes on the heels of projections that 210,000 Oregonians will lose health insurance as a result of federal cuts to Medicaid in the budget bill passed in July.

The resulting loss of funding for health care, together with related downstream financial effects, will cause state economic production to fall by about $40.7 billion. State and local tax revenues are projected to drop by $2.5 billion. Oregon is expected to lose about 2,400 jobs, not just in health care but across our economy.

The impacts will be felt all over our state, but rural Oregonians will be hit hardest. In rural communities already facing hospital closures, workforce shortages, and fragile local economies, an influx of uninsured patients will drive up unpaid care costs and push some rural hospitals past the breaking point. This will worsen health care access and result in unprecedented price hikes for health care in rural areas.

Health care providers are not immune from the unaffordability of health insurance. For example, a small clinic in northeast Oregon that provides comprehensive health care services is seeing their 2026 group health insurance premiums increase nearly 30% — up from $1,000 per employee per month to $1,300 per employee per month. This is unsustainable. In an environment where all costs are increasing, reimbursements for providing care are stagnant, and fewer people will be insured, these increases threaten the clinic's ability to retain staff, maintain services, and fulfill their mission to provide comprehensive care to the community.

Oregonians must hold our Congressional delegation accountable for protecting constituents. Extending the ACA tax credits two or three years will save lives, stabilize health care costs, and support local economies.

In the longer term, health care does need deeper reform. There must be a better, more sustainable way. Oregon should continue to be a laboratory of health policy innovation, and we are hopeful that Oregon's Universal Health Plan Governance Board can help our state find a better path towards a more effective, stable system for the future.

But today, the decision before Congress is simple: protect families and communities by extending the healthcare tax credits that keep millions insured.

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Dr. Evan Saulino is a family physician and health system strategist with more than 20 years of clinical and leadership experience spanning direct patient care, teaching, statewide policy advising, and quality improvement. Dr. Saulino represents a coalition of Oregon physicians, health professionals, community clinics, and hospitals serving rural Oregon who are working to protect and improve health care access and coverage. Over the coming months, this group is organizing a series of constructive health care conversations including key community members and legislators in rural communities.