The Congressional Budget Office found permanently expanding ACA enhanced premium tax credits prior to the federal government’s Sept. 30 fiscal year end would boost the insured population by 3.8 million people over the next decade, while increasing the deficit by $350 billion.
Sens. Chuck Schumer, D-N.Y., Bernie Sanders, D-Vt., Jeff Merkley, D-Ore., and Ron Wyden, D-Ore., requested the CBO and the Joint Committee on Taxation to evaluate how health coverage policies would affect both the federal budget and the number of people with insurance.
However, if the expansion occurs after Sept. 30, CBO estimates a smaller increase in 2026 enrollment and lower costs to the government. CBO estimates gross premiums would not be adjusted downward after the start of open enrollment — Nov. 1 for most marketplaces — and enrollees would have a smaller chance of seeing effects of the expanded credit structure while selecting a plan for 2026.
Another policy CBO investigated was the potential impact of nullifying a June 2025 final rule aimed at promoting “marketplace integrity.” Retracting this rule would prompt a $40.3 billion increase in deficits over 2026 to 2035, but a larger insured population, just not at the same magnitude as other policy changes.
Revoking other restrictions would prompt a more substantial coverage expansion. CBO estimates insured people would increase by 2.8 million in 2030 and by 2.9 million in 2035 but would still lead to a $271.9 billion deficit increase.
