Congress must act to keep health coverage affordable

UPDATE 11/10/25: A version of this column originally appeared in The Alpena News. Since its publication, eight Democrats in the U.S. Senate have joined Republicans to move a federal funding measure forward that would end the federal government shutdown. However, this measure does not include an extension of the enhanced premium tax credits. While Republicans have agreed to a future vote on the tax credits, it is uncertain at this time whether this vote will occur. While the League recognizes that it’s important for federal employees to be able to get back to work, this deal is deeply disappointing as it will likely have a negative impact on the health and well-being of millions of Americans, including hundreds of thousands of Michiganders.

Enhanced premium tax credits are critically important in lowering the cost of health care for millions of families in the U.S., including more than 484,000 people in Michigan. The credits help people to afford their Affordable Care Act Marketplace coverage and, yet, Congress still has not taken action to ensure they don’t expire at the end of this year. 

Open enrollment began on Nov. 1, which means marketplace enrollees and new shoppers are already likely starting to see stark increases to premiums and out-of-pocket costs relative to years past. And if Congress lets the enhanced premium tax credits expire, these dramatic spikes in health care coverage costs will remain, with premium increases of more than 75% expected for the average enrollee and 90% expected for those living in rural areas. To put that into further perspective, a typical 60-year-old couple making $85,000 will see monthly marketplace premiums jump from $602 to $2,647 — an annual increase of roughly $24,500. 

With so many changes in the marketplace this year, there are several important things for marketplace enrollees to be mindful of now that open enrollment has begun. First and foremost, they should be sure to actively update their information and compare available plans. Second, they shouldn’t rely on automatic enrollment as they may not realize their 2026 premiums have increased until they receive their first bill in January and will have very little time at that point to shop for other plans. And, third, they should be sure to read all notices from the marketplace and their insurer and respond to requests in a timely manner. 

Also, to avoid financial penalties, they should be sure to estimate their income as accurately as possible for next year, update their marketplace account as soon as possible if their income changes during the year (and have an assister adjust their advance premium tax credit amount), stay up-to-date with premium payments or get help if payments become unaffordable, and reconcile their premium tax credits during tax season in 2026. 

Our reminders aren’t just for marketplace enrollees, however. We also have an important reminder for our members of Congress: Affordable health care coverage is more important than ever and should be protected at all costs. 

Being without health coverage often means choosing between delaying or skipping needed health care or taking on medical debt. And for many in our state who don’t receive coverage from their employer or through Medicaid or Medicare, the expiration of these credits will force them to become uninsured. According to recent data, more than 76,000 Michiganders could lose health insurance because their premiums would be too costly to afford.

Currently, the number of people in Michigan without health coverage is relatively low at 5%, but that could all change if Congress doesn’t act soon. Families in every county throughout our state who are already struggling to make ends meet due to the rising cost of groceries, rent and prescription drugs will undoubtedly be faced with impossible choices if the credits do expire. The people who will be hit especially hard include workers in restaurants and retail stores as well as child care providers and home health aides. Small business owners and self-employed workers will also be impacted as they make up about 1 in 4 of marketplace enrollees. 

The negative impact of having many thousands of people withdraw from the marketplace also cannot be understated. It will mean a smaller pool of people who are likely sicker, which will further drive up premium costs for everyone who remains. In today’s economy, families can’t afford higher premiums or deeper medical debt. 

We urge Congress to act swiftly to protect enhanced premium tax credits for the hundreds of thousands of Michigan families who need them.