The Affordable Care Act (ACA) premium tax credit subsidies for health insurance that were
passed by Congress during the Covid pandemic are due to expire on January 1, 2026. Twenty
million Americans are expected to see a premium increase of at least 75% on average without
the subsidies. The link to the KFF premium calculator is https://www.kff.org/interactive/calculator-aca-enhanced-premium-tax-credit/. The Congressional
Budget Office projects that 4.2 million Americans will not be able to afford these premium
increases over the next decade and will become uninsured, resulting in more emergency room
visits for care, less preventive care, and increased strain on struggling rural hospitals. With this
crisis looming, it is worthwhile reviewing the major benefits provided by the passage of the ACA:
● Pre-existing conditions protection from denied coverage or higher premiums.
● No lifetime or annual dollar limits for coverage of essential health benefits.
● Young adults continue coverage on a parent’s plan until age 26.
● Required coverage of 10 categories of essential health benefits.
● Required coverage of preventive services (immunizations, screenings, well-woman
visits) without out-of-pocket costs.
● Income-based premium tax credits for payments made through the health insurance
marketplace.
● Expanded Medicaid eligibility for non-elderly adults up to 138% of the Federal Poverty
Level.
● Insurance companies must spend at least 80% of premium dollars on health care and
quality improvement instead of administrative costs.
● Phasing out of the Medicare Part D “donut hole” to make prescription drugs more
affordable for seniors.
Despite the benefits of the ACA described above, we are left with a broken, dysfunctional, and
unsustainable health care financing structure that prioritizes maximal insurance company profits
and shareholder returns instead of paying for patient care. In health care financing, we are told
by those profiting from the system that we must not interfere with the “free market” where “the
laws of supply and demand provide the sole basis for the economic system, without government
intervention” (Investopedia). Yet recent history shows that insurance companies are repeatedly
demanding government subsidies (handouts) so that premiums can be “kept affordable.” Since
2017, Minnesota has spent over $1 billion on state-funded reinsurance to lower premiums on
the individual health insurance market and incurred $500 million in federal funding cuts to
MinnesotaCare because of the reinsurance program. Minnesota spends 2 to 20 times more
than other states for reinsurance, which threatens MinnesotaCare while depleting the general
fund (SF 0333 Fact Sheet). These government subsidy demands are coming from a health
insurance industry where seven large insurers made a record-breaking $71.3 billion in profit
and their CEOs were paid more than $146 million in 2024! (HEALTH CARE uncovered, 8/6/25).
It is no wonder that the United States spends twice as much per person than the average of
other wealthy countries of the world and has worse population health outcomes than these
countries. We need to emulate these outperforming countries by having a system of universal
health care without the profit motive, as would be provided by improved Medicare for All and the
Minnesota Health Plan. (mnhealthplan.org).
