What If the American Rescue Plan Act Premium Tax Credits Expire? Coverage and Cost Projections for 2023

Matthew Buettgens, Jessica Banthin, and Andrew Green
April 2022
PDF
Type
Report
Publication
Urban Institute

The American Rescue Plan Act of 2021 increased premium tax credits (PTCs) for Marketplace coverage and extended eligibility for those credits to people with incomes above 400 percent of the federal poverty level (FPL). Consequently, Marketplace enrollment reached a record high during the 2022 open enrollment period. However, these enhancements are set to expire after 2022. Without extension, Marketplace enrollment will most likely fall and the number of people uninsured will increase. In addition, after the public health emergency expires, we previously estimated that more than 14 million people will lose Medicaid coverage. The Marketplace would be the only affordable coverage option for many of those losing Medicaid. So, extending the enhanced PTCs would increase the likelihood that such people will sign up for Marketplace plans, rather than becoming uninsured.

In this report, we estimate health coverage and costs in 2023 both with and without extension of the American Rescue Plan Act's enhanced PTCs. We find the following:

  • If the enhanced PTCs expire, 3.1 million more people will be uninsured.
  • If the enhanced PTCs are not extended, individuals and families enrolled in the Marketplaces or other nongroup coverage will pay hundreds of dollars more per person each year in premiums. People eligible for PTCs with incomes between 150 and 400 percent of FPL would pay more than $1,000 more per person for a silver plan. People with incomes above 400 percent of FPL who would lose PTC eligibility would pay roughly $2,000 more per year.
  • The non-Hispanic Black population, young adults, and people with incomes between 138 and 400 percent of FPL will experience the largest coverage losses if the enhanced PTCs expire.
  • Enhancing PTCs will increase the federal deficit by $305 billion over 10 years.

The report was published by the Urban Institute in April 2022. It has received coverage from CNN, Axios, Bloomberg, and Business Insider, among other media outlets. The report was also cited in a series of fact sheets released by the White House following the passage of the Inflation Reduction Act, which included a three-year extension of the enhanced subsidies.


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