Larry Levitt

KFF’s @larrylevitt.bsky.social appeared on @kqedforum.bsky.social and spoke about our latest research on the ACA enhanced premium tax credits, including the potential impact on people and politics if the tax credits aren’t extended.

🎧 Listen to the full episode: https://on.kff.org/4awg4nY

Congress Scrambles to Address Healthcare Funding Before Year End | KQED We talk about the negotiations unfolding on Capitol Hill, what we’re hearing from the White House and how the issue could shape the 2026 midterm elections.

🎙️ON AIR:

We're talking to @kff.org's @larrylevitt.bsky.social, @thebulwark.com's @citizencohn.bsky.social and @liccardo.house.gov of California's 16th District about the negotiations unfolding as Congress scrambles to address healthcare funding before year end.

❓What are your Qs?

📻 Listen:

Doubling of out-of-pocket premiums for ACA enrollees isn’t hypothetical. We estimate premium payments will rise by an average of 114%, or $1,016, next year if the enhanced tax credits end.

Democrats are united around extending enhanced ACA tax credits.

Republicans have a four dimensional puzzle to solve around opposition to the ACA, federal spending, insurance regulation, and abortion. It's hard to solve for all that, plus avoid big cost increases for enrollees.

In trying to come up with a health care proposal right now, Republicans face the same dilemma as with any health reform plan. Laying out the details will make clear who wins, but also who loses.

Calculator: ACA Enhanced Premium Tax Credit The ACA’s enhanced premium tax credits are set to expire at the end of 2025. This calculator estimates how much out-of-pocket premiums would increase for families if Congress does not extend the credi...

Our calculator estimates out-of-pocket premiums for ACA enrollees with and without enhanced tax credits by age, income, family size, and zip code.
www.kff.org/interactive/...

One of the weedy things I worry/wonder about is (1) how aware of the premiums changes enrollees are, and (2) among those who aren't aware, how many are having their premiums automatically debited from their bank accounts?

A 60 year old in Charleston, WV making $65,000 would see their annual out-of-pocket premium increase from $5,525 to $27,864 if the enhanced ACA tax credits expire.

The same 60 year old living in Charlottesville, VA would see their out-of-pocket premium go from $5,525 to $12,616.

An individual ACA enrollee making $25,000 would see their annual out-of-pocket premium increase about 12 fold, from $98 to $1,165, if the enhanced ACA premium tax credits are allowed to expire at the end of the year.

One of the challenges in explaining the impact of enhanced ACA tax credits expiring on premium payments is that it varies so much, depending on income, age, family size, and geography. The average increase would be 114%, or $1,016, but there is a wide range.

That unfortunately sounds right to me.

I'm not sure how to say this any more simply. ACA premium tax credits are for people, not insurer. People receiving a tax credit can use it to buy any plan in the ACA marketplace. As an administrative mechanism, the government then forwards the tax credit to the chosen insurer.

Trump Discovers, Yet Again, That Health Care Policy Is Hard He’s floating compromise ideas on Obamacare subsidies, but Republicans in Congress aren’t interested.

Concepts of a health care plan?

Still in the conceptual phase, it would seem

www.thebulwark.com/p/trump-disc...

No Republicans voted for the Inflation Reduction Act, giving Medicare authority to negotiation drug prices. But, the Trump administration seems to be all in, touting big discounts in the latest round of negotiation.

KFF’s @larrylevitt.bsky.social advises signing up now, because once enrollment open ends you won’t have another chance.
You can sign as a hedge, in case a deal is passed, and decide to drop out later if there’s no deal.

It's always harder to get things done in Washington than to stop things. In the case of the ACA right now, inaction means 22 million people will see their out-of-pocket premiums increase by 114% on average on January 1.

People have to sign up for ACA marketplace coverage by December 15 to have health insurance January 1. Even if Congress passed an extension with tweaks to the premium tax credits, computer systems could not be reprogrammed immediately.

I was genuinely interested to see President Trump's health plan today. Guess we'll have to wait longer.

(Yes, it's stupidly complicated, but no, funding CSRs would not do anything to reduce out-of-pocket costs relative to status quo; it would instead raise premiums for some enrollees in most states.)

CMS Plans to Share Data with ICE Could Exacerbate Immigrant Families’ Fears About Accessing Health Coverage and Care This policy change will likely exacerbate fears among immigrant families about health officials and providers sharing patient information with ICE, increasing their reluctance to access health coverag...

CMS just issued a notice that it will start sharing personal data of Medicaid enrollees with ICE for immigration enforcement, including data on immigration status, location, and phone numbers. @kff.org Quick Take discusses the impact this could have on immigrant families
www.kff.org/quick-take/c...

The Scott proposal hews most closely to Trump’s various remarks.

“While ACA plans would still be required to cover people with pre-existing conditions under the Scott proposal, it is likely that the ACA Marketplace would collapse in states that seek a waiver under his approach.”

Proposals from Senators Scott and Cassidy to convert ACA premium tax credits into health accounts present trade-offs that benefit healthy people at the expense of sick people. Senator Scott's proposal, in particular, would destabilize the insurance market in some states.
www.kff.org/affordable-c...

ACA enrollment growth since enhanced premium tax credits were put in place is dramatically skewed towards red states. Yet, no Republican voted for the ACA originally, or for the enhanced tax credits.
www.kff.org/affordable-c...

Why We Are Stuck with Prior Authorization Review Prior authorization review frustrates patients and physicians, but we likely can’t just eliminate it. In his new column, President and CEO Dr. Drew Altman discusses why, and why the focus is now inste...

No one likes prior authorization review. But could we get rid of it? My new column: www.kff.org/from-drew-al...

The trillion dollars in health care cuts passed by Republicans earlier this year are backloaded and mostly won't take effect before the midterms. Letting enhanced ACA tax credits expire would take effect January 1, leading to big out-of-pocket premium increases and more people uninsured.

We also need to know *which* subsidies are in play. As I understand it:

Paragon has proposed converting CSRs to HSA contributions

Cassidy has proposed converting ePTCs to HSA contributions

Trump has proposed (I think? this is least clear) converting *all* subsidies to HSA contributions.

Right. Under the Cassidy plan, there would no longer be enhanced ACA premium tax credits. But, people who buy bronze plans with high deductibles would instead get a government contribution into an HSA account.

Wonky but important question for understanding the effects of proposals to convert ACA premium tax credits to health savings accounts: How big would the contributions be? Would they vary by income, age, and geography in the same way as the premium tax credits?

Really excited to share our latest survey of immigrants work @kff.org. We're able to see how immigrants are faring now amid increased immigration enforcement compared to 2023. Check out our KFF reports below and stories from @nytimes.com

KFF/New York Times 2025 Survey of Immigrants | KFF KFF/New York Times 2025 Survey of Immigrants The 2025 Survey of Immigrants, a partnership between KFF and The New York Times, takes an in-depth look at the experiences of immigrants during the first y...

Our brand new survey of immigrants in partnership with @nytimes.com explores immigrants views and experiences under the second Trump administration. It finds increased fear, health and economic challenges amid immigration enforcement, but a remarkable resilience as well

www.kff.org/kff-nytimes-...