UPPER DELAWARE RIVER, NY & PA — While the federal government did not find a way to extend expiring health insurance tax credits by the end of 2025, health policy experts say there’s still hope for a solution in 2026. 

A series of tax credits called the Enhanced Premium Tax Credits (EPTC) lowered the cost for eligible people to get insurance through the Affordable Care Act’s individual health care marketplaces. These plans are available through New York State of Health in NY and through Pennie in PA. 

While some level of subsidies always existed, the EPTC, introduced during the COVID-19 pandemic, made more people eligible for tax credits and increased the amount that they cover. 

Those credits expired at the end of 2025, with politicians divided about whether or how to extend them, leading to predictable results. 

“The big increases [in premiums] that everybody worried about happened, because nobody intervened,” said Katherine Hempstead, a national health policy expert with the Robert Wood Johnson Foundation. 

Hempstead said that the state health care exchanges may have seen lower enrollment as a result of the higher premiums, as well as more people shifting to a lower-cost “bronze” plan. 

There isn’t detailed enrollment data out yet from the Centers for Medicare and Medicaid Services, said Louise Norris, a health policy analyst for healthinsurance.org. What figures have been released show enrollment tracking fairly close to where it was last year. 

However, it remains to be seen how many people will activate their coverage, said Norris: many people might have been on auto-renewal, but will drop their coverage once they realize how high the new premium will be. And even if people still have some level of coverage, that doesn’t mean they’ll have the same access to health care as they did before, especially if they chose to switch to a less expensive plan, said Hempstead; if people have an $8,000 deductible, they’ll chose to postpone care or to pay for less care. 

The state of play

Health care has become a defining political issue ahead of the 2026 midterms. The Trump-led Big Beautiful Bill (BBB) stripped almost $1 trillion from the Medicaid program nationwide, while creating a $50 billion Rural Health Transformation Fund to help health care in rural areas, which will be the most affected by cuts to Medicaid. Democrats have pushed for the EPTC to be extended; by and large, Republicans have expressed concern about fraud, waste and abuse in the program, including CMS administrator Dr. Mehmet Oz in a December visit to Scranton. 

While the federal government couldn’t find a solution by the end of 2025, and thus allowed the credits to expire, politicians are still working on a variety of potential solutions. 

Early in January, the House of Representatives voted to pass a “clean” three-year extension of the tax credits, with 17 Republicans joining with Democrats to get the bill through. These Republicans included PA-08 Rep. Rob Bresnahan, who has come under repeated fire for his vote on the BBB and its impact on healthcare. 

“Obamacare has failed to deliver on its promise of lowering insurance costs, and families in NEPA are paying the price. But the only thing worse than a three-year extension of these credits is to let them expire with no solution or off-ramp. I voted for this because, as of right now, it is the only path forward that keeps discussions alive to protect the 28,000 people in my district from immediate premium spikes,” said Bresnahan. 

The House bill in its current form is unlikely to pass in the Senate, said Norris. However, she said, a bipartisan group in the Senate is working to come to some sort of potential extension compromise, one which could include elements such as a new income cap or a minimum premium requirement. 

It is “possible that we’re still going to see a fix, but [we] have to look at it as a maybe,” said Hempstead.  

While the national picture remains unsettled, Norris and Hempstead both encourage people to keep some level of coverage while things get worked out. 

When the American Rescue Plan first created the EPTC, it did so in March, and backdated the subsidies so that they applied from January onward. Anyone who overpaid before the subsidies kicked in got to claim that amount back on the next year’s taxes. In addition, a special enrollment period opened up for people to upgrade their coverage or to sign up. That same playbook might happen again if a deal gets worked out for their extension, said Norris. 

Norris recommends people to keep their coverage, even if they have to drop to a less expensive plan, and to keep an eye on the federal landscape. “I’ve seen so many situations where people decided to roll the dice, went uninsured, and then something bad happened,” she said. 

A less expensive plan might not allow people to take care of their day-to-day health needs, but would still protect them if something unthinkable happens, said Hempstead. Even so, it’s not an ideal situation for people. 

Emergency coverage is “better than nothing—but clearly it’s not as good as having affordable access to care,” Hempstead said.