What the Health? From KFF Health News Crunch Time for ACA Tax Credits
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Dec 11, 2025 
In this lively discussion, Sheryl Gay Stolberg of The New York Times, Anna Edney from Bloomberg, Maya Goldman of Axios, and health policy expert Linda Blumberg delve into the impending ACA tax credit deadline. They warn about potential coverage losses and rising premiums as Congress debates subsidy extensions. The guests also tackle the implications of shifting vaccine policies influenced by Robert F. Kennedy Jr. and dissect the Republican health proposals, emphasizing how segmented risk pools can harm access and affordability for those in need.
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Expiration Threatens Enrollment Gains
- Enhanced ACA tax credits doubled marketplace enrollment from ~12M to ~24M.
- Letting them expire will likely drive many people to drop coverage and raise premiums.
HSA Alternative Could Destabilize Markets
- The Crapo–Cassidy HSA proposal offers tax-preferred HSA credits but no premium subsidies.
- Experts warn it would push people into high-deductible plans and risk a 'death spiral'.
Risk Pool Composition Drives Premiums
- If subsidies lapse, healthier people may opt out, leaving sicker enrollees and higher average costs.
- That imbalance would raise premiums and reduce marketplace stability.