The Big Story 

As the future of enhanced premium tax credits for the Affordable Care Act (ACA) remains in limbo, so do the millions of consumers who have come to rely on the cost-friendly plans for their health care needs. 

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Current analyses project that the groups who will experience the highest loss in insurance coverage if the ACA premium tax credits aren’t extended are young adults; Black, non-Hispanic people; and those in the middle bracket of income. 

The number of people projected to lose coverage if the credits expire has ranged between 3 million and nearly 5 million.

These estimates are based on a report by the Urban Institute, which found that uninsurance would rise by 25 percent among adults aged 19 to 34, 30 percent among Black, non-Hispanic people, and 26 percent among those making between 250 and 400 percent of the federal poverty level. 

According to Matthew Buettgens, senior fellow in the health policy division at the Urban Institute, young people stand to be most affected because they’re more likely to be working while not receiving health coverage through their employer. 

Although the ACA allows for young adults to remain on their parents’ health insurance until the age of 26, Buettgens noted people who could stay on their parents’ plan were unlikely to have sought coverage through the marketplace. 

He additionally warned that people in states that haven’t expanded Medicaid eligibility are more likely to be impacted as well because the tax credits cover individuals who would otherwise have been covered by Medicaid expansion. 

 And ripple effects from the ACA Marketplace are anticipated. If people are pushed out of the ACA plans, they are more likely to enter the non-group market, which can cause a worsening risk pool for those who don’t get health insurance through Obamacare or an employer. 

Lorelei Salas, former supervision director for the Consumer Financial Protection Bureau, said she’s concerned that people will be pushed towards inferior financial products like junk plans and payday loans to cover their medical costs. 

“A lot of people who are not able to pay those monthly premiums if they double — and then if you actually do have health needs that you cannot wait — you’re going to be on the lookout. You’re going to be searching for something else, for alternatives that are not regulated,” said Salas. 

Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health.

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