The government provides Enhanced Premium Tax Credits (EPTCs) to help qualifying individuals and families afford healthcare coverage. These tax credits are paid to insurers and reduce the premiums that qualifying beneficiaries would otherwise need to pay for their coverage. In doing so, EPTCs help to support the entire healthcare system – not only by ensuring that individuals who would otherwise go without coverage can receive care but also by working to support the broader system which provides care and undergoes tremendous financial strain in caring for the most vulnerable. Without EPTCs, hospitals in disadvantaged and rural areas with large Medicaid populations could be forced to close or reduce services as a result.
More broadly, the December 31, 2025, expiration of EPTCs stands to disproportionately harm rural Americans when compared to their urban counterparts, due to the increased reliance of rural areas on these credits to offset healthcare costs. Losing these credits would trigger premium increases in rural areas across the country where the need is greatest, and would inevitably force some enrollees to lose coverage as a result.
Over 50%
Just over half (51%) of marketplace enrollees who would lose tax credit eligibility are ages 50-64. If the enhanced tax credits expire, a 60-year-old couple making $82,000 (just over four times poverty) would see their premium payment triple or more in most parts of the country. In South Dakota, the aforementioned couple would see a premium increase of $25,000. In Wyoming, they would see an increase of $37,000. In Alaska and West Virginia, the couple would see a premium increase of $40,000+.
Four Million
The expiration of the EPTCs would disproportionately affect those in rural areas and those with lower incomes. Specifically, the most rural states in America would experience, on average, a 30% decrease in marketplace coverage and a 37% increase in their uninsured populations. Nationwide, an estimated four million people would become uninsured.
96% Higher
Benchmark premiums in rural areas are about 10 percent higher than in urban areas, meaning that rural residents benefit the most from enhanced premium subsidies. One study by Covered California found that 85,000 people living in rural areas would experience an average premium increase of 96% following EPTC expiration, compared to just 62% for urban residents.