Congress passed into law legislation in 2021 that allowed additional eligibility for enhanced premium tax credits to help certain individuals and families purchase insurance on the health insurance marketplaces. This change has been especially impactful for those in rural areas, who tend to face higher premiums and fewer coverage options, in allowing them to access needed health care coverage.

These EPTCs are scheduled to expire at the end of 2025. If they are not extended, millions of Americans will lose coverage or incur significantly higher costs. The largest disruptions will be felt by those who can face some of the highest challenges: the individuals and families living in rural communities.

Below are three takeaways about the potential impacts of ending EPTCs on rural patients and communities:

Increases in Coverage Disruptions and Uninsured Populations. Analysis by KNG Consulting for the AHA shows the most rural states in America would experience, on average, a 30% decrease in marketplace coverage and a 37% increase in their uninsured populations.

Higher Taxes Via Premium Increases. The EPTCs helped millions of rural Americans purchase affordable commercial health care coverage and access necessary health care. The expiration of this policy would both harm the health of entire rural communities and raise individuals’ taxes via premium increases.

Exacerbated Health Care Access Challenges. Rural populations have more complex health needs, face longer travel distances to providers and have fewer health care options. The EPTCs are a fundamental support for keeping critical health care access in rural communities and their expiration would exacerbate these existing access challenges. 

The AHA urges Congress to continue the EPTCs as they remain an important part of increased access to health care coverage and high-quality care for patients and communities served by hospitals, health systems and other providers. See the AHA fact sheet for more details.