Cost of Healthcare Delays
The cost of healthcare continues to be one of the most critical issues for Americans, even among MAHA voters, as profiled in Drew Altman’s recent column. To date, proposals for healthcare affordability, including the extension of enhanced premium tax credits for ACA enrollees, remain without a path forward. With the annual federal appropriations process in motion, we may soon see national proposals for how our tax dollars will be spent. Approaches that improve healthcare affordability must be a priority item in this process. Comprehensive coverage remains a longstanding need in our country.
One of the last major systemic developments in improving comprehensive health coverage was through the ACA, which made Medicaid expansion possible. Kaiser Family Foundation has an interactive map that gives status updates on State Medicaid Expansion. Right now, 41 states and the District of Columbia have expanded Medicaid to adults making up to 138% of the Federal Poverty Level (FPL). This was made possible by the Affordable Care Act. Currently, 10 states have yet to implement expansion, leaving a benefits cliff in place for those with incomes at 100% FPL. People in Medicaid expansion states also face benefits cliffs at the 138% threshold, but may choose to purchase a plan on the ACA Marketplace. There are still premium tax credits available to individuals making between 100 and 400% FPL.
The loss of enhanced premium tax credits has meant greater healthcare costs for Americans. The Commonwealth Fund estimated that this has resulted in losses of $35 billion in federal healthcare assistance in 2026 alone. A handful of states restructured existing subsidy programs to help support people with the greatest need. The state of New Mexico has been the only marketplace to retain 2025 affordability standards in 2026, bridging the lost federal funds. In other states, everyday consumers have been either making up the additional costs themselves, or foregoing coverage. Over 1 million people have chosen not to renew their ACA coverage this year so far and that number may grow as people make the decision to drop coverage if they find it too expensive. Health insurance is an important first line of defense for all of us to seek proactive treatment and support for our health and wellness, especially when public health crises emerge that require large numbers of people to proactively seek care.
Comprehensive coverage must also adapt to the emerging health needs affecting our communities. Health Affairs recently outlined a vision for adapting our health insurance systems to serve as an essential form of climate adaptation, as people nationwide respond to climate change in real time. For people with disabilities, additional health coverage to support with things like indoor air filtration and access to cooling systems would be an essential piece of an independent living guarantee during times of public health crisis. Disabled people can be impacted the most by the temperature extremes, low air quality, power outages, infectious disease risks, and flood-related changes that characterize climate disruption. Simultaneously, we’re seeing the delay of HHS rules that would implement an update to Section 504 of the Rehabilitation Act, which has pushed federal agencies and contractors to ensure that programs do not discriminate people with disabilities from receiving benefits and services. People with disabilities deserve to know their health and well-being are supported. Strengthening our systems of coverage and home care are two critical ways to do this.
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