Laura Minzer: Health care advances jeopardized if premium tax credits expire

The Affordable Care Act celebrated its 15th anniversary earlier this spring. During its tenure, it has been both praised and criticized for its approach to solving some of the deepest flaws in our complex and fragmented health care system.

Among those challenges was the reality that millions of Americans, including countless Illinoisans, lacked access or could not afford basic health care. Since then, millions of Americans, including hundreds of thousands of Illinoisans, have secured health insurance. However, I'm concerned that many of those coverage gains may evaporate if the U.S. Congress and the Trump Administration allow the enhanced premium tax credits to expire.

Prior to the ACA, private health insurance was often out of reach for those who had a pre-existing condition, lacked coverage through their employer, did not qualify for Medicaid or Medicare, or any combination of the above. The insurance reforms advanced in the ACA achieved what the private market could not do on its own without risk of collapse: removing medical risks from the health insurance underwriting process.

In addition, the ACA also solved the Medicaid eligibility gaps that existed for lower-income, single, and childless adults. Illinois moved swiftly to expand its Medicaid program to cast a wider coverage net. As a result, nearly 93% of Illinois' population has private or public health insurance, which is higher than the national average.

This growth in the number of insured Illinoisans has also been driven by the passage of enhanced premium tax credits in 2021 under the American Rescue Plan Act, which was later extended through the end of this year as part of the 2022 budget reconciliation process. Prior to ARPA, only those households with incomes of 400% of the federal poverty level or less could qualify for these tax credits. Enhanced premium tax credits are now calculated based upon a percentage of the total household income.

Given that health care costs are outpacing the rate of inflation, and the cost of health insurance reflects those systemic costs, it made sense to expand these tax credits to help more middle-income households purchase more affordable health insurance. When the enhanced premium assistance was first implemented, enrollment in Illinois' marketplace jumped by more than 32,000 and since 2021, enrollment in Illinois' marketplace has grown by almost 40% with the state reporting record enrollment this year with nearly 466,000 enrollees.

According to 2025 data released by Centers for Medicare and Medicaid Services, the average premium on the Illinois' health insurance marketplace without the assistance of a premium tax credit was $674 per month. However, the average premium for the nearly 90% of marketplace enrollees who qualified for the premium tax credit was reduced to $143 per month.

These positive trends could be disrupted if Washington fails to extend the enhanced premium tax credits before they expire at the end of the year. The Congressional Budget Office estimated that more than 2 million Americans, including tens of thousands of Illinoisans, would lose coverage in 2026 if these tax credits were allowed to expire.

This decline would continue in 2027 and beyond, and these figures would be further compounded if funding for Medicaid expansion is cut. In fact, Illinois estimates that individuals in the central and downstate region of the state will see an average increase in their premium of 65% and the marketplace would experience an estimated 30 percent decrease in its enrollment, virtually unwinding the growth the state has seen over the past five years.

As a representative of our health insurance industry, we have more work to do with our provider and drug maker partners to make high quality health care more affordable and improve the consumer experience for those patients we collectively serve. However, without access to health insurance, consumer interaction with the health care system would be greatly diminished.

In other words, we cannot effectively address the remaining flaws and improve our health care system if millions of Illinoisans, and many more millions of Americans, lose coverage and are excluded from the system altogether.

We strongly urge members of Congress and the Trump Administration to preserve coverage for Illinoisans by extending the enhanced premium tax credits and protecting those who are currently served by our Medicaid program.