That’s Amanda’s story – a small business owner in Idaho whose life changed overnight after her partner Robert’s cancer diagnosis. Today, the premium tax credit is what keeps her family insured. If Congress allows it to expire at year’s end, millions like Amanda could face devastating premium hikes and lose access to affordable care.
As a health care provider, it might seem like a distant policy issue – something that affects insurance paperwork more than patient care. But in reality, the fate of the health care tax credit will ripple through hospitals, clinics, and communities in ways that touch every provider.
Let’s look at what’s at stake, and why it matters to you.
The Looming Expiration: More Than Just a Number
Premiums Could More Than Double
If the enhanced Affordable Care Act (ACA) premium tax credits expire, subsidized enrollees could see their net premiums rise by over 114% – jumping from about $888 in 2025 to $1,904 in 2026 on average.
That’s not just a number. For many families, that’s rent money, groceries, or the difference between seeing a doctor and going without care.
Uninsured Surge, Provider Strain
Experts project that 7.3 million people could lose their subsidy-based coverage, and 4.8 million could become uninsured. For hospitals and clinics, that means more patients showing up without coverage – and a surge in uncompensated care that squeezes already-thin margins.
Rural hospitals, in particular, could face difficult choices about staffing, services, or even survival.
Economic Ripple Effects
Research from the GWU Milken Institute and the Commonwealth Fund estimates that states could lose $34 billion in GDP and $2 billion in local tax revenue, with hundreds of thousands of jobs at risk – many of them in health care.
When patients lose coverage, communities lose stability. Providers lose paying patients. And local economies lose one of their biggest engines: a functioning health system.
The Provider Perspective: Challenges, Risks & Strategic Responses
1. Shifting Payer Mix & Revenue Risk
As the number of uninsured patients rises, hospitals may see a heavier reliance on emergency departments and charity care. Safety-net and rural hospitals are already struggling under similar conditions. A change in the payer mix can translate to delayed payments, lower margins, and increased financial strain.
2. Telehealth’s Uncertain Future
The pandemic proved that telehealth saves lives and expands access. But unless Congress extends key flexibilities, Medicare telehealth reimbursements could roll back after September 2025. For providers who have invested in digital infrastructure and trained staff, that uncertainty is unnerving.
3. Payment & Reimbursement Changes
This year’s Medicare Physician Fee Schedule reduced the conversion factor by about 2.2%, and new billing codes for e-visits and virtual check-ins are reshaping outpatient care economics. In addition, reimbursement for some off-campus hospital services may now align with lower Ambulatory Surgery Center (ASC) rates – meaning careful coding and financial planning are more critical than ever.
4. Policy & Regulatory Turbulence
The proposed 2025 Budget Reconciliation Act – dubbed by some as the “One Big Beautiful Bill” – carries sweeping implications for the ACA, Medicaid, and Medicare. Combined with the proposed HHS reorganization into a new Administration for a Healthy America, the entire regulatory environment may soon look different. For providers, that means keeping a close eye on compliance and funding shifts.
5. Technology & Litigation Pressures
From AI-driven diagnostics to automated claim appeals, technology is rewriting the rules of healthcare. Startups like Counterforce Health are already using AI to challenge claim denials, changing how payers and providers negotiate reimbursement. But with innovation comes liability – who’s accountable when an algorithm errs? Providers must navigate these gray zones carefully.
What Providers Can Do – Starting Now
Advocate & Educate
Patient stories like Amanda’s can make policy personal for lawmakers. Engage in local advocacy or provider associations. Educate your staff and patients about potential premium changes and enrollment options. The more people understand what’s at stake, the harder it becomes to ignore.
Assess Financial Resilience
Review your payer mix and stress-test your revenue against a potential rise in uninsured patients. Audit your billing workflows, coding accuracy, and denial management – especially if AI tools or automation are part of your process.
Invest Wisely in Technology
Continue to build telehealth capacity, but prepare contingency plans if reimbursement rules tighten. Evaluate AI partnerships with care – balancing efficiency with accountability and patient safety.
Collaborate & Network
Join coalitions or provider alliances to amplify your voice. Work closely with state health agencies, Medicaid programs, and major payers. Collaboration strengthens leverage when reimbursement or credentialing policies shift.
Monitor & Adapt
Stay informed. Track Congressional updates on tax credit extensions, and follow provider news sources like Cigna’s newsroom or payer bulletins for updates on billing and coverage policies.
Why This Isn’t Just a Policy Story – It’s a Provider Story
Amanda’s journey reminds us that behind every policy debate are real lives – patients trying to survive illness, families trying to stay afloat, and care teams fighting to help them.
If millions lose their subsidies, providers will bear the brunt – through unpaid bills, overworked staff, and moral fatigue from watching preventable crises unfold.
The expiration of the health care tax credit isn’t just a line item in the federal budget. It’s a turning point.
For providers, this moment calls for preparation, empathy, and action. The question is not whether policy will change – it’s whether we’ll be ready when it does.
