By Dan Russo
Editorial
One of the causes of the 43 day government shut down that ended in November 2025 was the inability of Democrats and Republicans in Congress to agree on whether or not to extend temporary premium enhanced tax credits (PTCs) that allowed millions of people nationally to buy health insurance at cheaper rates through the healthcare marketplace set up by the Affordable Care Act (ACA). During the COVID-19 pandemic, lawmakers passed the American Rescue Plan Act of 2021 (ARPA), which established the PTCs.
“The enhanced tax credits both increased the amount of financial assistance already eligible ACA Marketplace enrollees received as well as made middle-income enrollees with income above 400% of federal poverty guidelines newly eligible for premium tax credits,” stated a report from KFF, a self-described non-partisan health research organization. Before these tax credits, KFF claims that many middle income earners struggled to afford ACA plans. This measure boosted ACA enrollment from 11 million to a record 24 million, according to the organization.
In an editorial in late November, Barb Arland-Fye, editor emeritus, joined the U.S. bishops in calling for an extension. About 112,000 Iowans depended on the premium tax credits in 2025, the Iowa Insurance Division’s spokesperson told The Catholic Messenger. An estimated $630 million in taxpayer subsidies went to the 112,000 Iowans, or about $5,625 each.
In an October letter, U.S. bishops told Congress PTCs should survive: “but must not continue to fund plans that cover the destruction of human life, which is antithetical to authentic health care.” Arland-Fye made the case that once an extension goes into effect, congress should address the “structural flaws” of the ACA, which were described in greater detail by Iowa insurance commissioner Doug Ommen: “The temporarily enhanced federal subsidies Congress passed in 2021 and 2022 have only masked the underlying problems that have existed in the Affordable Care Act since its creation,” he said on his agency’s website.
On Jan. 8, the U.S. House passed legislation extending the credits for three years, with a 230-196 vote. Seventeen Republicans joined Democrats in voting for the extension. As of May, the bill is still held-up in the U.S. senate where it is “under negotiation,” according to reports. Opponents of the extension question whether the country can afford to pay for PTCs long-term, given the tens of billions they would add to the national debt.
Now that PTCs are expired, the people who benefited from them are trying to figure out health insurance coverage as prices skyrocket. “In 2026, Affordable Care Act (ACA) premiums increased by more than 20%, in large part because insurers believe they are facing increased risk due to the expiration of enhanced premium tax credits and other policies,” states a January report from the Commonwealth Fund, a private foundation which focuses on health policy. This year there is a smaller, but still significant increase in the average cost of employer sponsored insurance plans, according to the foundation.
It is long past time for the senate to vote on the PTC extension. People deserve a clear yes or a no rather than living in uncertainty. It is also time for the country to face the fact that without dramatic structural reforms, the ACA will fail. If ACA marketplace premiums continue to go up at the current rate, this failure will occur soon. It is up to congress to either fix the ACA at its foundation or come up with a bi-partisan alternative that is better. If federal lawmakers need ideas, they should talk to all 50 of our nation’s state insurance commissioners.
Dan Russo, editor
