Abstract
BACKGROUND AND OBJECTIVES
Enhanced premium tax credits (PTCs) for Affordable Care Act Marketplace plans expired in 2026. We described families across income groups potentially affected by PTC policy changes and simulated net premiums.
METHODS
We performed a cross-sectional simulation using the 2023 National Survey of Children’s Health, classifying families by federal poverty level (FPL) into the following income groups: ineligible (above state Medicaid threshold, below 100% FPL), Medicaid (below state threshold), 100% to below 250% FPL, 250% to below 400% FPL, and at or exceeding 400% FPL. We estimated family premiums using scaled state benchmarks and modeled net premium costs under (1) enhanced PTCs, (2) enhanced PTC expiration, and (3) PTC repeal using ordinary least squares regression adjusting for state fixed effects and family sociodemographics.
RESULTS
Families in PTC-relevant income groups had greater material hardship and children with more health conditions but less access than higher-income families. With typical family ages, adjusted net premiums as a percentage of income would be 1.8% (100% to
CONCLUSIONS AND POLICY IMPLICATIONS
Enhanced PTC expiration would increase net premiums substantially, particularly for families at or exceeding 400% FPL; full PTC repeal would produce large, regressive premium burdens for lower-income families with children. PTCs should be re-enhanced and not repealed to support American families.