September 24, 2025

Without renewal of healthcare tax credits, premiums expected to jump 70%

Karley Abramson, health policy associate for the Research Council, speaks with Guy about her most recent paper, Upcoming Changes to the Affordable Care Act (ACA) Tax Credits Will Also Disrupt Michigan’s Health Care System, which details how the One Big Beautiful Bill Act would likely result in about 200,000 fewer Michiganders having health care.

_{#FactsMatter podcast host Guy Gordon and Health Policy Research Associate Karley Abramson}

This includes an estimated 100,000 people who will become uninsured because Congress did not renew or extend the Enhanced Premium Tax Credit (EPTC). The other 100,000 individuals are expected to become uninsured due to new administrative requirements that may create barriers to people qualifying for EPTC. Estimates suggest that premiums would increase in Michigan by about 70 percent on the marketplace, or over $800 per year, if the credits are allowed to expire.

Data indicates that about 8 million fewer Americans will have health care over the next decade.

“Our research found that of the 530,000 Michiganders who purchase health care through the ACA, more than 350,000 are covered by a tax credit-supported plan,” said Abramson. “As a result of the tax credit enhancement under the 2021 American Rescue Plan 2021, expanding both the size of the credit and who is eligible, premiums for plans sold on the Marketplace have been much cheaper for many enrollees compared to 2020 and earlier.”

Since the introduction of the Enhanced Premium Tax Credit, nationwide coverage through the Affordable Care Act marketplace has doubled.

“Cascading effects across the state.”

Abramson also addressed how the end of these tax credits goes far beyond the financial hardship they impose on Michiganders who directly use them.

“This would lead to worse health outcomes for people across Michigan. More uninsured people mean health care costs will go up for everyone, in the form of higher health insurance premiums paid by individuals and employers,” she said.

More uninsured people mean health care costs will go up for everyone in the form of higher health insurance premiums, the paper notes. Michigan hospitals are likely to experience increased rates of uncompensated care, which will exacerbate their financial burdens and potentially lead to reduced services and even closure. Much in the same way that the OBBBA Medicaid cuts are expected to impact Michigan, people not buying private insurance through the Marketplace will likely have cascading effects across the state.

“Combined with cuts to Medicaid — which already threaten to strip health care from hundreds of thousands of Michiganders — health care in our state faces a dire downward spiral that will put people’s health, safety and well-being at risk.

The paper also addresses solutions, with the most immediate being for policymakers to renew the EPTC before the end of this year.

“We also believe that state legislators in Lansing can create a Michigan-specific tax credit to assist those purchasing insurance through the marketplace or provide incentives for preventative care and vaccinations,” said Abramson.

“Doing nothing will have serious long-term ramifications for Michigan families, Michigan businesses and Michigan’s economy.”

Citizens Research Council of Michigan · Without renewal of healthcare tax credits, premiums expected to jump 70%

Transcripts

Show Transcripts

Hide Transcripts

Guy Gordon (00:00.558)
Hello and once again welcome to the Facts Matter podcast. I’m Guy Gordon, your host for the Citizens Research Council. Look at issues of the day affecting Michigan families across the spectrum. We’ve talked a lot about the One Big Beautiful Bill Act, about its immediate impact, but there’s a part of it that really needs to be explored because while many tax cuts and tax credits were extended under the OBAA, there was one that was allowed to expire and it could be very impactful for Michigan.

families and so while we have focused previously on what happened this time we’re focusing on what didn’t. I’m joined by Carly Abramson who is our health care analyst here at the Citizens Research Council for Michigan and Carly welcome to Facts Matter. Once again you’re a longer veteran than I am. So it is interesting I mean there was so much rhetorical drama around this bill that there were several things that really did get overlooked and one of them

Thank you for.

Guy Gordon (00:59.82)
was the impact on the ACA, the Affordable Care Act, or what we’ve commonly called Obamacare. Tell us about that.

Yeah, so there were some things that were overlooked and we’re talking about this kind of in the bigger context of what all of these changes might mean when you add them all together and its larger impact on individuals, even the ones that don’t lose their insurance coverage and the larger healthcare system. So specifically what we’re talking about is to go a little bit into the history of the ACA and these tax credits. The ACA always implemented

some kind of tax credit or subsidy to incentivize people to enroll and use the marketplace exchange to get health insurance coverage. In 2021, those tax credits were enhanced and expanded. So not to get into the weeds a little bit, but the kind of the income eligibility cap was eliminated for the people who were able to get these subsidies and the amount in which they would have to pay.

was capped. So essentially through these different mechanisms in 2021, more people were able to get larger subsidies by purchasing their health insurance through the ACA marketplace.

So was this pre-Trump that this happened? Was this under the Biden administration? Yes, correct. So Republican can say, we’re just rolling back the, we’re still in the same place that we were before the Biden administration. How will people, how will this manifest itself? How will people know that they no longer have this coverage or this benefit or that it’s shrinking?

Karley Abramson (02:37.048)
So.

Karley Abramson (02:44.184)
Well, when they go to enroll, what happens is the marketplace is designed so that you can kind of calculate and see exactly what subsidy you would be receiving. And so it’s essentially a tax credit, but you’re able to take advantage of that money right away. is discounted from the calculation when you’re determining what your premium will be. And so what might happen is people who were able to purchase health insurance at a reasonable or affordable price may go to

renew it or enroll and find that the premium has increased a lot. And their options are to consider whether or not they can afford this, to try to make cuts other places or to simply not enroll, which would lead to fewer individuals having health insurance coverage, which has larger ramification.

Do we know how many fewer at this point or is it only uneducated yet?

So there’s projections of, I think about like 200,000 fewer Michigan residents would be enrolled over the next decade, I believe. And so there are some projections about exactly how much on average people would be paying more. The average estimate is about $800 a year.

For some people it could be more or some people could be less. It would just depend on where they fall on that income eligibility.

Guy Gordon (04:07.574)
Okay, so take away number one, this could get expensive and to find out how expensive it’s going to be for you and your family, best to go to the ACA website and do some calculations.

Right, right, yeah. So you would go on there and see, okay, is this a big difference from what it was last year? Now we have to make a different decision about whether or not we’re even going to purchase coverage because this is for a pocket of people that either don’t have access through an employer for whatever reason, they’re either get workers or contract workers, or they don’t fall within the Medicaid coverage. this is a separate bucket of people who don’t have access

to Medicaid for eligibility reasons, but also don’t have access through their employers. So self-employed people, this is a separate bucket of individuals who are also at risk for losing health care coverage, simply because it might become unaffordable for them to be able to enroll.

So, I mean, if Newton had a law of politics, says, you know, there’s the initial effect and then there’s the ripple effect and then there’s also the unintended consequence. Do we know what ripple one and two might look like?

Yeah, you know, knowing what we know about the insurance industry and how it works, essentially, you want the insurance pool to be as large as possible and you want healthy people to be included because that is what helps keep overall premiums down. How insurance companies work is they spread the risk across premiums. And so what we project will be likely to happen is that the people who are now deciding, do I want to purchase health insurance this year?

Karley Abramson (05:47.884)
the ones who decline to are most likely the ones that are going to be the healthiest. And those are the ones that you actually want in your insurance pool because they are the most cost effective because we usually don’t have to spend very much on healthy people. So once that kind of group of healthy people are now absent from the overall insurance pool, that is likely to raise premiums across the board.

So we’ve got those folks out there that may be saying, well, look, I’m not on Medicaid, and I’m not on the ACA, so this isn’t going to affect me. Not necessarily true.

Absolutely, it definitely, you know, that’s just how the insurance model works. will raise premiums across the board. Even if you have insurance coverage through your employer, a lot of these insurance companies operate both in this private sector and through employers. So, you know, they’re usually taking up space in both of these places. And so that premium distribution is likely to increase for everybody, whether or not

you have, you know, there’s the individuals losing direct access, but then there’s the premium increase, which everybody is at risk for.

Well, and then there’s ripple number two, which is the cost of uncompensated care that those people will still perhaps as healthy as they may be may have need for health care. And that usually means they’re either going to be in the ER or, you know, some kind of, you know, level one access.

Karley Abramson (07:19.234)
Definitely, right. So the ripple effects of this are pretty large in the sense that generally, you know, we try to get more and more people insured to reduce costs because when you’re insured, number one, you are more likely to access preventative care, which is generally much more cost effective if you can get access to that preventative care to prevent that tertiary care that you might need down the line, which ends up being more expensive.

You know, 200,000 certainly seems like a large number. mean, it’s the population of Grand Rapids. But in a percentage context, do we know of the insured population currently in the state of Michigan? What percentage 200,000 would be?

That I don’t know off the top of my head, but I can so Yeah, it’s it’s I don’t I don’t know exactly what that percentage is but it’s important to remember that this is a Chunk of a bigger story of people losing coverage through other mechanisms as well, right? And so we have this chunk of people This is that that chunk that might lose coverage whatever that percentage is. I’m not sure but there are other avenues the

Medicaid issue that we had written about before. You compound these, feed into each other and you have a larger group of uninsured people that are kind of feeding into the system.

And I want to talk about, you know, we’ve had some time span since our previous papers and podcasts on the Medicaid impact. I want to get to that in a moment, but I don’t recall ACA being much in spite of the fact that it’s highly subscribed. I don’t recall it being much of a football over the OBIDA bait.

Karley Abramson (09:05.122)
Yeah, I mean, I don’t know what, I didn’t hear much about it. And so this is why, because kind of just went kind of under the radar is maybe something people assumed would have been renewed since lots of different tax.

The purpose of this was to extend the whatever 17 different correct.

Right. And this one, from the data that we have, the enrollments through the marketplace exchanges nationally since 2021, since these tax credits were extended, doubled. It had stayed consistently around 12 million people. It went up to almost 25 million people between 2021 and 2025. And so it really had a large impact on the number of people who were enrolling. And I think in

It was those that fell through the cracks on the original ACA.

Correct, right. And so, right, because there was the initial income eligibility. If you were above 400 % of the poverty line, you were just cut off. And so now there are people who without that cap or with that cap being removed, when we’re reverting back to the way that it was, if you are now 401%, you will now go from having a subsidy to having nothing.

Karley Abramson (10:22.606)
And so that could have a big difference for an individual.

Taking this action and it is consequential but putting it in the larger picture could some of these costs be offset by other for lack of a better term goodies that were in oba the extension of the standard deduction I mean a lot of these things if If other things had been allowed to lapse like this it would have been even more catastrophic for a lot of these families that are in that lower working poor

Right. It’s possible. mean, the general, there hasn’t been that much discussion exactly about how those tax cuts would kind of trickle down to helping families deal with different kinds of expenses and things that they are dealing with. The general theory behind it is that it would, but we don’t have a lot of data or understanding of kind of the timeline for that or exactly how that would man about.

How are county health officials and state health officials reacting to this? Have they had time to look at this and say we’re gonna need a plan for those 200,000 people?

Well, I hope so because it is something that we definitely need to be bracing ourselves for. the federal government, could decide to extend these tax credits. There’s still time for them to do that, in which case this might all be moot, but there hasn’t been discussion about that.

Guy Gordon (11:46.702)
The could come in and be pressured by some other interest groups to cover this. Michigan Hospital Association certainly have a vested interest in making sure this is extended.

Right, on the state level, they could come in and try to reorganize their budget to try to create their own tax credit for people to try to incentivize them to enroll. But we are experiencing very tight budget and a lot of controversy and debate. About what to do.

experiencing no budget.

Karley Abramson (12:19.904)
you know, puts the state in a difficult position. And so there definitely, there needs to be a state of awareness to kind of be bracing ourselves for those, you know, potential outcomes.

So before I let you go, mean, this comes on top of this. These are layers of impacts that are coming from OBBA, the other one being in Medicaid. Now, to be very clear, Medicaid was not cut as an appropriation. Correct. You know, we’ve seen this kind of perversion of semantics here, but they did change.

eligibility what other changes have happened and we have greater clarity now that maybe we did a month ago about the real world impact

Yeah, so the changes, like you said, it’s not like they can just cut Medicaid. They can’t cut a funding source because without getting too complicated, it is a state matching federal program. And so the way that you reduce costs is by reducing the number of people who are enrolled. And so essentially the bill kind of creates certain barriers to people getting enrolled because that is the whole point is that is how you reduce the costs.

Well, you can look at it that way, you can say it’s about taking it back to what the original intent was, which was not to cover necessarily able-bodied adults.

Karley Abramson (13:48.824)
Correct. So it didn’t change the eligibility requirements about, you know, those able-bodied adults or not. What it did was add these extra work requirements, which through, you know, administratively have been shown to be barriers for people. And there’s a little bit more complicated administrative kind of pathway as to why that is a barrier for people. But, yeah, so essentially there’s a question of kind of who should or shouldn’t be covered by Medicaid.

And this doesn’t say that these able-bodied people shouldn’t be covered. It’s just making it harder to have them covered, right? And so, yeah, essentially whether…

you they’re disabled, whether they’re caring for a loved one, whether they’re pregnant. Right. And I mean, I don’t know what all the waivers are. I know there were waivers built in in Michigan. Right. It was pretty when we had our work requirements, they were there were some pretty generous waiver opportunities there. Are those are are is it similarly as broad under OBBA? And how high is the bar?

to verify that, know, the verification and compliance task.

mean, higher than it was. And that is also something we see in this ACA component as well. There’s pieces of this ACA component where previously they would have to had, if there was some kind of discrepancy in the information that they put in and that there needed to be some kind of verification process, they would still receive the tax credit. But now with this change, they would have to wait to receive it until they can prove.

Karley Abramson (15:31.36)
and submit all of that paperwork. And so there’s these little administrative hurdles in both areas that just make it a little bit harder.

Well, as a guy that signed up for Medicare recently, I got to tell you that, mean, it’s so it’s daunting. And I can see why some people would say, I can’t navigate this. I’m just not going to sign up, which would be a shame because they may be eligible. So, I mean, are there some discussions at the state level or at the county level and health departments of, hey, we’re going to need some navigation help for these people, especially.

Yeah, and I mean, I think there’s discussions. There’s no action that I know of, of actual, because they would, there would ideally be some sort of resources from the state to be able to guide local communities to be able to do this. But one of the major selling points of the ACA or of the ACA marketplaces was to kind of create that navigational system for people to be able to go to one place and

and figure all of that out because like you said, navigating government benefits in particular can be very daunting. It’s daunting for me and you, let alone, you know, people who are really struggling day to day and have 8,000 other stressors that they’re dealing with. This might be one that just kind of falls through the cracks.

And yet there’s the other argument which is look this is taxpayer funded both at the state and federal level. If it’s important to you a little bit of work or a little bit of effort, diligence shouldn’t be an insurmountable thing.

Karley Abramson (17:01.111)
Right.

Karley Abramson (17:09.998)
And to that is, again, this is why we focus on the broader impact on everybody. Whatever your political opinions about the certain people losing coverage, whether or not they should or shouldn’t, the takeaway for us is we want to focus on those ripple effects of how this will affect the everyday person.

And because we’re not just talking about the insurance premiums, these hospitals that rely on uninsured pool of people coming to use their resources, these hospitals, particularly in rural areas, they operate off of very, very tiny margins.

We just saw a UP hospital, think in the last 48 hours say, we’re closing our birthing center. Now, can you imagine in the UP, and mean, if you’ve ever driven up there, I mean, you don’t even have cell service in some of these places. We’re an expected mom that may be in crisis. That’s a scary.

I mean, yeah, you just, you may lose access to the places and the doctors that you have become accustomed to. that’s, know, the comfort and familiarity of an established doctor shouldn’t be underrated in terms of helping people get to the doctor. And so closing, you know, not just because things will be far away, but because those kinds of personal relationships that you’ve built.

with your established provider might now be gone and you have to reestablish that somewhere else even farther.

Guy Gordon (18:44.524)
Well, we’re also in many areas we have doctor deserts and that just makes recruiting those doctors even harder. I was at a speech that was done up in Petoskey from the McLaren Hospital CEO and he said, you know, it is a never ending struggle to get people to locate, you know, in these more farm-flung areas. Okay, so takeaway number one, when the pool of the insured shrinks, we all pay in a variety of ways and we need to be mindful of that as a policy consequence.

Takeaway number two, if you’ve been operating in the ACA marketplace, you need to go there and find out what the impact of these tax credit expirations are. Hopefully you’ll find the information you need there. Hopefully they’ve updated the website to include all of this so that you will find out whether the tax credit you’ve been relying on is still there.

Right, yes, and then you can, know, individual families will make their decisions, but it’s, it is in the, it’s in everyone’s interest to make it easier to enroll. And we’re again, not just for those individuals, but for the larger ramifications of how this impacts the entire healthcare system.

All right, Carly Abramson, take one and take two there. We appreciate it very much. Yeah. All right. You can find Carly’s full analysis of this on the CRC website, crcmish.org, crcmish.org. And while you’re there, we invite you, if you like this podcast, if you like the bias free, obsessively objective approach to these policy questions that we have.

Thank you.

Guy Gordon (20:17.622)
invite your friends to subscribe to this podcast and the variety of platforms. You can do that again at CRCMich.org. And we want to remind you that we do not receive government funding. We do not receive money from lobbyists. We are totally donor supported. And if you appreciate the work of the Citizens Research Council, you can show that appreciation by maybe throwing a few coins in the kettle at CRCMich.org. Until next time, I’m Guy Gordon for the Citizens Research Council of Michigan.

Have a great day.

The Citizens Research Council of Michigan has been providing lawmakers, academics, the media, philanthropists, business leaders, voters, and all Michiganders with factual, unbiased, independent information on significant issues concerning state and local government organization and finance for over a century. Our research is available to you. Go online at CRCmich.org

and on all the social media platforms, Twitter, Blue Sky, Facebook, Instagram, LinkedIn, and download our research. Check out our numerous papers and blogs and listen to our podcasts. And while you’re there, please consider supporting our research with a donation. This has been a Facts Matter podcast, a presentation of the Citizens Research Council of Michigan.

fmp-obbb-healthcare.txt
Displaying fmp-obbb-healthcare.txt.

Without renewal of healthcare tax credits, premiums expected to jump 70%

Karley Abramson, health policy associate for the Research Council, speaks with Guy about her most recent paper, Upcoming Changes to the Affordable Care Act (ACA) Tax Credits Will Also Disrupt Michigan’s Health Care System. The paper details how the One Big Beautiful Bill Act will likely result in about 200,000 fewer Michiganders having health care. This includes about 100,000 who will become uninsured because Congress did not renew or extend the Enhanced Premium Tax Credit (EPTC). The other estimated 100,000 individuals are expected to become uninsured due to new administrative requirements that may create barriers to people qualifying for EPTC. Data indicates that about 8 million fewer Americans will have health care over the next decade. “Our research found that of the 530,000 Michiganders who purchase health care through the ACA, more than 350,000 are covered by a tax credit-supported plan,” said Abramson. “As a result of the tax credit enhancement under the 2021 American Rescue Plan 2021, expanding both the size of the credit and who is eligible, premiums for plans sold on the Marketplace have been much cheaper for many enrollees compared to 2020 and earlier.” Since the introduction of the Enhanced Premium Tax Credit, nationwide coverage through the Affordable Care Act marketplace has doubled. Abramson also addressed how the end of these tax credits goes far beyond the financial hardship they impose on Michiganders who directly use them. “This would lead to worse health outcomes for people across Michigan. More uninsured people mean health care costs will go up for everyone, in the form of higher health insurance premiums paid by individuals and employers,” she said. More uninsured people mean health care costs will go up for everyone in the form of higher health insurance premiums, the paper notes. Michigan hospitals will likely see increased rates of uncompensated care, which will worsen hospitals’ financial burdens and potentially lead to reduced services and even closure. Much in the same way that the OBBBA Medicaid cuts are expected to impact Michigan, people not buying private insurance through the Marketplace will likely have cascading effects across the state. “Combined with cuts to Medicaid — which already threaten to strip health care from hundreds of thousands of Michiganders — health care in our state faces a dire downward spiral that will put people’s health, safety and well-being at risk. The paper also addresses solutions, with the most immediate being for policymakers to renew the EPTC before the end of this year. “We also believe that state legislators in Lansing can create a Michigan-specific tax credit to assist those purchasing insurance through the marketplace or provide incentives for preventative care and vaccinations,” said Abramson. “Doing nothing will have serious long-term ramifications for Michigan families, Michigan businesses and Michigan’s economy.”