The League of Women Voters of the United States (LWVUS) joined a letter to Congress urging a clean extension of the set-to-expire Affordable Care Act (ACA) enhanced subsidies or premium tax credits.
December 8, 2025
Dear Leader Thune, Leader Schumer, Speaker Johnson, and Leader Jeffries,
On behalf of the National Women’s Law Center and 128 state and national organizations, we write to strongly urge you to pass a clean extension of the enhanced Affordable Care Act (ACA) premium tax credits (PTCs). It is imperative that Congress act without further delay—as insurers have already set premium rates for the upcoming year assuming the enhanced PTCs are expiring. The longer Congress waits, the harder it will be to offer relief to millions of Americans with skyrocketing premiums, with women and low- and middle-income people hit the hardest.
The enhanced PTCs, originally expanded under the American Rescue Plan Act of 2021 and extended through 2025 in the Inflation Reduction Act of 2022, have made health coverage through the Marketplace more affordable and accessible than ever before. In 2025 we saw record-breaking Marketplace enrollment, with nearly 12.7 million women enrolled, a 95% increase in women’s enrollment since 2021. Ninety-two percent of all 2025 Marketplace enrollees received PTCs, with an estimated nearly 11.7 million women receiving PTCs to help pay for their health insurance premiums. Resulting in premium payments being cut by an estimated 44% ($705 annually) for enrollees receiving PTCs.
If these enhanced PTCs expire, the health and economic consequences will be devastating to women and low- and middle-income people. It is expected that Marketplace out-of-pocket premiums will skyrocket by over 75% if the enhanced PTCs expire:
- Average net premiums will be more than four times higher ($919 versus $169) for people with subsidized Marketplace coverage and incomes below 250% of the Federal Poverty Level (FPL);
- Net premiums will more than double, from $1,171 to $2,455, for those with incomes between 250% and 400% of the FPL.
- Adults aged 50 to 64 are projected to see even higher premium increases, with annual premium spikes between $599 and $4,574.
These premium increases will undoubtedly compound existing barriers to affordable health care coverage for women, particularly women of color, and low- and middle-income people. Millions of people will be priced out of coverage and be at increased risk for uninsurance, negating monumental gains made in reducing uninsurance since the enactment of enhanced PTCs in 2021. In fact, the Congressional Budget Office (CBO) estimates that failing to extend the enhanced PTCs will result in 4.2 million more uninsured people by 2034. An estimated nearly 2.2 million of those 4.2 million would be women and over 3.1 million would be people of color. This is in addition to the 10 million people who stand to lose their health coverage due to H.R. 1 (OBBBA), according to CBO.
Women and low- and middle-income people already face significant challenges affording health insurance and health care-related expenses. Unaffordable health care costs force people with fewer financial resources to delay or forgo critical care, exacerbating existing health disparities. Uninsured women are less likely than those with coverage to have consistent access to care and to receive essential preventive services, such as cancer screenings. Gaps in such care are particularly harmful for women, particularly women of color who already experience high rates of chronic conditions.
Additionally, as Congress is negotiating an extension of the enhanced PTCs, we urge you to reject any further attempts to restrict abortion coverage. Any such attempts would ultimately amount to a thinly-veiled effort to derail negotiations over these essential tax credits. Cost is a major factor in whether people are able to access the abortion care they seek, and often insurance coverage is the difference between a person getting the care they need and being forced to carry an unwanted pregnancy to term. Any claims that additional restrictions on abortion coverage are needed to ensure that no federal funds are spent on abortion coverage are false. The ACA already treats abortion different from other health care services; it explicitly prohibits federal funds from being used to pay for abortion coverage in Marketplace plans, with limited exceptions for cases of life endangerment, rape, and incest. Any attempt to further restrict coverage for abortion care in ACA Marketplace plans will ultimately deny people the freedom to make the best decisions for their bodies, lives, and futures.
Congress must extend the enhanced PTCs before the end of the year, or millions of women and low- and middle-income people’s health and financial wellbeing will bear the brunt of drastically higher premiums that will follow. It is critical that Congress act swiftly to preserve enhanced PTCs and ensure the millions of women and low- and middle-income people who rely on these PTCs continue to have access to affordable and comprehensive health coverage.
Sincerely,
See Here for List of Signatories