Enrollment in health insurance through the Affordable Care Act (ACA) marketplaces has more than doubled since 2021, with over 23 million Americans enrolled in coverage in 2025. Premium tax credits help make coverage more affordable by lowering premium costs. Millions of Americans benefited when the tax credits were made more generous in 2021, significantly boosting enrollment. However, these credits are set to expire at the end of this year unless Congress takes action to extend them. Without them, premiums will become more costly, and up to 4.8 million people are estimated to become uninsured. Other changes to the marketplaces could further harm enrollment: an additional 3.2 million people are estimated to become uninsured by 2034 because of Congress’s budget reconciliation law (H.R. 1) and the Marketplace Integrity and Affordability final rule.
