Fault Lines, Deadlines, and Doing the Right Thing: Extend the EPTC

Call them COVID-19 credits if you must – let’s not waste time debating semantics. We recognize that the Enhanced Premium Tax Credit (EPTC) issue has become polarized because of its origin, initial purpose, and the nature of its extension. And that is unfortunate because circumstances can change – and without sufficient adaptation we arrive at the actual root of the problem. 

We should also level set for a moment before going any further. Despite public framing that may suggest otherwise, EPTCs are not the reason for the federal government shutdown. Linking the two only fuels partisanship. Don’t take the bait. 

Insurance costs and care access are a lot more expensive today than they were even just four years ago when the EPTCs were first created by the American Rescue Plan Act – and we, collectively, haven’t taken very many meaningful steps to improve the situation.

Complexity can’t be the sole excuse – because the reality of the moment is that the EPTCs are no longer just a helping hand amid a generational public health emergency. They have made insurance coverage possible for millions of Americans, including allowing for significantly reduced or zero-cost premiums for those most in need. Today, they are a critical lifeline to coverage and continued access to care for many individuals and families across the income scale who participate in the Affordable Care Act insurance marketplaces. 

The Congressional Budget Office has estimated that up to 4 million people in the United States who purchase health insurance coverage through the marketplace exchanges will drop or not renew their coverage for next year if the EPTCs are allowed to expire as scheduled at the end of 2025. That’s nearly 1 in 5 people currently enrolled, and it doesn’t even account for those who may downgrade their coverage due to rising premiums. In North Carolina alone, that suggests at least tens of thousands may lose coverage outright, with many more forced to scale back or abandon plans. 

Speaking of North Carolina, we understand through helpful resources such as this map from Keep Americans Covered, that more than a million people purchased insurance through the marketplace in 2024 and approximately 980,000 (roughly 95.5%) of those participants benefit from EPTCs. Estimates vary on potential coverage losses, but they would likely be at least in the tens of thousands with hundreds of thousands more reevaluating their coverage decisions without the benefit of these enhanced credits.  

And look, we’ve heard and can even appreciate some of the concerns and criticisms about continuing the program in perpetuity as currently constituted. The year-to-year cost of an extension is not insubstantial. Maybe there are even reasonable arguments and proposals related to capping future income eligibility. There are also needed and overdue conversations about the factors involved in the exponential rise not only in healthcare insurance premiums – estimated to be at least a 75% increase for most marketplace purchaser – but in the overall costs of care. 

Yet we have a very real problem with time – because we’ve waited too late once again to get serious on options and alternatives. Complexity is real, but it cannot be an excuse.  And let’s be honest about the actual, practical deadline in play. It isn’t Dec. 31, as often quoted – it’s open enrollment, beginning in less than 30 days. Individuals and families will make decisions and weigh options very soon. There will be no political winners of an impasse or expiration, just constituents potentially facing the loss of a critical personal safety net. 

Why not turn to employers for coverage options? That may not be as viable an option as one may assume. North Carolina ranks first in the nation for high employee-borne costs, and only about 1 in 4 small businesses can offer any coverage at all. For many, the marketplace isn’t an alternative, it is the only choice. These are all bigger and more layered issues, and we welcome those conversations – but finding a consensus on the broader path forward is not going to happen within the next three months.  

Those who participate in the exchanges and who have a reliance interest in access to additional support during the challenging circumstances of incredibly high premium rate increases should not be punished for policy inaction.  

We respect that the EPTCs were meant to be temporary – but it’s disingenuous to characterize them as a luxury rather than a necessity for millions of people.  

Extending the EPTCs isn’t an indulgence, it’s an investment that ensures access. Let’s provide families with certainty and peace of mind for the upcoming year as quickly as we can, while committing to the long-term reforms our healthcare system desperately needs.