On behalf of the Coalition on Human Needs, we strongly support legislation before you Thursday that will rein in skyrocketing health costs by extending the enhanced Affordable Care Act (ACA) premium tax credits, which have been keeping health care more affordable for 20 million people. The need to prevent the ACA enhanced credits from expiring is urgent given the scheduled end of open enrollment next week on December 15. Every day Congress delays means more people will become uninsured as they despair over unaffordable premium increases.

The Coalition on Human Needs is made up of human service providers, faith groups, policy experts, and civil rights, labor, and other organizations concerned with meeting the needs of people with low incomes.  From our partners and networks across the country and from everyday people, we regularly hear concerns expressed about rising costs of basic needs, including health care. While making tax provisions permanent that largely benefited the wealthy and large businesses  in this summer’s budget package, Congress failed to extend the enhanced Affordable Care Act (ACA) premium tax credits. We are in a health care crisis, and the combined impact of Congress cutting nearly $1 trillion from Medicaid this summer and not extending these tax credits will decimate health care in this country for years to come.

Extending the ACA tax credits is politically popular and morally necessary. Many Americans are experiencing sticker shock over skyrocketing premiums due to the loss of these tax credits. Without the enhanced tax credits, most people on the health care exchange will see their premiums more than double, and people in every state and Congressional District (many lower-income workers) will lose coverage altogether. Modeling shows this will lead to a loss of jobs in every state along with reduction of state GDPs and lost state/local tax revenue. We urge members of Congress to immediately work together to avert this looming health crisis by passing a clean multi-year extension of the current ACA enhanced premium tax credits.

Ultimately, the Coalition on Human Needs supports the Protecting Healthcare and Lowering Costs Act of 2025 to repeal all the harmful health care provisions in H.R. 1 and make permanent the enhanced Advanced Premium Tax Credits for purchasing marketplace health insurance plans. We hope you will look to undo the damage of H.R. 1 and instead strengthen basic needs programs including Medicaid and SNAP.

Instead of addressing the impact of skyrocketing premiums as families enroll in health plans for next year, we note that the proposal before you from the Majority, S.3386, does not include extending the ACA premium tax credits and will leave millions without health coverage. Health Savings Accounts (HSAs) cannot replace the premium tax credits. HSAs are used to pay for qualifying medical expenses; they cannot be used to cover health insurance premiums, so don’t provide the help that 90 percent of people enrolled receive through the premium tax credits that are about to expire. If you can’t afford to pay for an increased health insurance premium, no HSA is going to meet your medical needs.  People who switch to bronze insurance plans to pay a lower premium will face dramatically higher deductibles, maximum out-of-pocket limits, costs of primary care visits, and costs for inpatient stays than under current law, with the biggest increases facing those with incomes of 100% to 150% of the federal poverty line.  For example, someone with this low income level will see their deductible rise from $52 to $6,513; their maximum out-of-pocket limit will rise from $1,759 to $10,028. The Senate Majority bill’s provision of up to $1,500 towards a Health Savings Account (HSA) will in no way allow them to afford these dramatically higher costs.  Families with modest incomes will not be able to afford to add thousands of dollars to their HSA.  They will forego unaffordable medical care, or, if that care becomes urgently needed, will be burdened with medical debt.

We urge you to reject the claim that payments to HSAs provide money to individuals rather than insurance companies.  No one who is not extremely rich can pay significant medical bills without insurance coverage.  S.3386 simply forces people into insurance plans that cover much less, requiring the individuals to pay much more.

Beyond our concerns with S.3386, we also oppose ending $0 premiums on plans with decent health coverage for people living at or near the federal poverty line as proposed by some policymakers. Without enhanced premium tax credits to help people with incomes between 100-150% of the federal poverty level afford a benchmark silver-level plan with $0 premiums, their coverage will cost between $28 and $82 per month, plus co-pays. $82 per month is almost $1,000 per year for a single adult earning as little as $23,475 annually. Without the enhanced tax credits, a family of three earning about $40,000 would go from paying no premium to an annual cost of $1,675. That’s tough to afford when rent, food, and heat swallow up much of the income for lower-income Americans. The end result is not just higher costs for millions of lower-income Americans, but also many will lose coverage with paperwork requirements as they lose access to zero-premium plans. This comes on top of the red-tape denials that will occur because of work reporting rules will ensnare many people who are actually eligible for Medicaid and other programs: people who are working or who are exempt because of disability or having a young child, but do not manage to supply documentation.  Evidence shows that millions of eligible Medicaid and SNAP participants, including children and people with disabilities, are likely to lose access to basic needs programs in the coming years due to complicated and frequent eligibility checks along with other paperwork requirements. Taking away access to zero-premium plans will only make this situation worse.

From our partners and networks across the country, every day we hear concerns expressed about rising costs of basic needs, including health care. While making tax provisions that largely benefited the wealthy and large businesses permanent in this summer’s budget package, Congress failed to extend the enhanced ACA premium tax credits. We recognize the urgency of this moment for action on health costs, given that 20 million Americans are in the process of shopping for health coverage through Affordable Care Act marketplaces now. We appreciate that policymakers on both sides of the aisle recognize that families may drop plans to continue health coverage when they see unaffordable premiums and are looking for policy solutions.

The only logical and effective way to lower health insurance costs quickly is to extend the enhanced Affordable Care Act premium tax credits in their current form. CHN urges you to support a clean extension of the enhanced ACA Premium Tax Credit to prevent its expiration at the end of 2025, and vote no on proposals such as S. 3386 that do not include an extension of the expiring credits and instead rely on proposals such as contributions to HSAs that will not help people with low and moderate incomes get coverage and afford care.

We look forward to working with your office on policies that will help American families meet their basic needs, including health care, in the days and months ahead.