Podcast: Break out of your bubble to build friendship & empathy

Current Issue

In the coming year, millions of Americans could see their health insurance premiums rise, or lose coverage entirely, as key federal supports for affordable care are set to expire. The American Rescue Plan Act of 2021 (ARPA) subsidies under the Affordable Care Act (ACA) marketplace, which were later extended by the Inflation Reduction Act, are scheduled to expire at the end of 2025. According to one analysis, if these enhanced subsidies expire, premiums on average could increase by 25-100 percent. At the same time, several states are reducing Medicaid rolls following the end of the pandemic-era continuous coverage requirement. Over 25 million people had been disenrolled from Medicaid and CHIP during this process in 2024. Together, these changes could redefine U.S. healthcare access, reigniting debates about public health and fiscal restraint.

Background

The ACA, passed in 2010, aimed to make health insurance more accessible for millions of uninsured Americans by expanding Medicaid eligibility and creating subsidized plans under the premium tax credit. The ARPA of 2021 significantly increased those marketplace subsidies, eliminating the 400% of poverty threshold for eligibility and reducing the percentage of income that enrollees must pay in premiums. As a result, the number of people eligible for marketplace subsidies increased from 18.1 million to 21.8 million from 2020-2021. Meanwhile, pandemic policies prevented states from disenrolling almost all Medicaid and CHIP enrollees for over three years. When this continuous coverage requirement ended in April of 2023, states began to reevaluate the eligibility of tens of millions of people. The expiration of ARPA temporary subsidies combined with the end of continuous Medicaid coverage set the stage for a contentious healthcare market next year.