USCM Urges Congress to Extend ACA Premium Tax Credits to Prevent Coverage Loss

The U.S. Conference of Mayors (USCM), led by Allentown Mayor Matt Tuerk and CEO Tom Cochran, has urgently requested Congress to extend the Affordable Care Act (ACA) enhanced premium tax credits set to expire on December 31, 2025. The expiration of these credits risks causing a severe health insurance affordability crisis that could result in nearly 5 million Americans losing coverage due to unaffordable premiums. Currently, premiums for subsidized enrollees average $888 annually, but are projected to surge to $1,904 in 2026 if the credits lapse, representing a 114% increase. Mayors emphasize the real-world impact of this policy, highlighting potential stressors on municipal health systems, safety-net hospitals, and local economies. Rising uninsured rates will shift the burden of uncompensated care to city governments, emergency departments, and community health centers, with estimated costs increasing by $7.7 billion in 2026. Additionally, safety-net providers and rural hospitals face revenue shortfalls exceeding $30 billion nationally, risking service reductions, closures, and diminished access to essential care. Municipal budgets, already under strain, cannot absorb such increased costs from unpaid emergency care. Furthermore, loss of coverage is expected to exacerbate mental health challenges such as depression, anxiety, and substance abuse, due to reduced access to preventive and behavioral health services. The financial pressure on families will intensify as they may have to choose between health insurance premiums and essential living costs like rent and utilities. The USCM appeal underscores health coverage as a fundamental necessity rather than a luxury, urging Congress to enact bipartisan legislative measures to extend the enhanced premium tax credits before the year-end deadline. The mayors express readiness to collaborate with Congressional leaders to maintain healthcare accessibility and economic stability for millions of Americans. This call to action reflects broader implications for industry stakeholders and regulatory frameworks affecting payer/provider dynamics, municipal financial planning, and healthcare delivery systems nationwide. Ensuring continued support via premium tax credits is positioned as critical for mitigating risks of increased uninsured populations and preserving safety-net provider capacities.