Summary:
- Congress must act by September 30 to extend ACA premium tax credits, or ACA premiums in North Carolina will rise 102% on average starting January 1.
- Without extension, 320,000 North Carolinians could lose coverage, while 600,000 more would face unaffordable cost hikes; rural hospitals risk closures and service cuts.
- Short-term or one-year extensions are inadequate; only a 10-year extension matching the duration of Trump’s 2017 tax cuts will stabilize the ACA marketplace and protect access to care.
Congress is currently engaged in a crucial debate over extending the expiring Affordable Care Act (ACA) enhanced premium tax credits. With Congress required to pass a 2026 federal budget (or short extension) by September 30 for the new fiscal year beginning October 1, the next two weeks are the last opportunity to extend these credits and prevent ACA premiums from increasing 102% on average for North Carolinians on January 1.
The ACA Premium Tax Credits: Central to the Budget Dispute
The ACA premium tax credits represent the primary budget issue in contention. Take action now: Please contact your Congress members and Senators to demand they extend the ACA premium tax credits for ten years, the same duration Congress extended Trump’s 2017 tax cuts in the “One Big Beautiful Bill Act” this past July.
ACA supporters now possess leverage they lacked during the earlier tax cut extension—they can demand ten-year tax credit renewal in exchange for budget support. However, delaying the premium tax credit vote beyond September 30 will make it too late to implement the credits for those enrolling starting November 1.
The Stakes for North Carolina
The numbers tell a compelling story. One million North Carolinians now receive coverage through the ACA health insurance exchange, up from 500,000 in 2020 due to Congress’s 2021 expansion of premium tax credits.
Without extension, the consequences are severe:
- An estimated 320,000 middle and lower-class working North Carolinians would lose health coverage
- Another approximately 600,000 residents would face additional financial strain absorbing massive cost increases
While North Carolina faces an average 102% premium increase from expiring tax credits, these increases will be much larger for older and lower-income residents. To determine exactly how much your ACA premiums would spike, click on this online calculator.
The Perfect Storm: Multiple Premium Increases
These increases stem solely from tax credit expiration. Insurance companies are separately raising ACA premiums in North Carolina an additional 27.8% in 2026, the largest increase in years. This extraordinary increase above normal healthcare inflation results from three new factors:
- A more costly ACA risk pool as healthy insureds drop coverage due to expiring tax credits
- Economic uncertainty
- New tariffs on imported drugs and health supplies
The Human Cost of Congressional Inaction
Failing to extend these credits carries devastating consequences. Loss of health coverage impedes access to timely healthcare. Studies estimate 8,800 Americans will die preventable deaths each year, while many others will delay treatment until requiring costlier emergency room care. Those paying massive premium increases will find their lives increasingly unaffordable.
Beyond individual impacts, ACA cuts will hurt rural hospitals, which operate on thinner margins. This will force complete closures or curtailment of maternity and other critical services. Losing local hospitals makes rural North Carolina less competitive economically and damages our overall state economy. It will impede job growth in healthcare—the fast-growing part of our sputtering economy.
Half-Measures Are Too Little, Too Late: Extend Credits for 10 Years
Only one solution prevents this healthcare and economic catastrophe: Congress must extend now the enhanced premium tax credits as part of the 2026 budget. This must happen no later than September 30 because new rates—with or without tax credits—need immediate online posting and publicity so insureds can make informed choices when enrollment begins November 1.
As the budget deadline approaches, congressional discussions have intensified over extending ACA credits. With rapidly changing negotiations, two critical points emerge:
- Short Budget Extensions Fail ACA Enrollees:
- A brief budget extension until late November without addressing tax credits arrives too late for ACA insureds. Advanced tax credits must be embedded in ACA website rates before insureds begin considering options and enrolling November 1. While a short extension prevents government shutdown, it cannot prevent advanced tax credit unavailability next year. This irresponsible delay creates unnecessary havoc for ACA insureds and our healthcare system.
- One-Year Extensions Perpetuate Harmful Uncertainty:
- Proposed one-year tax credit extensions represent equally poor policy. While convenient for politicians—kicking decisions past the November 2026 election—they perpetuate ACA insurance pool uncertainty, a key driver of premium increases.
- The responsible approach creates marketplace stability and certainty through ten-year extension. This mirrors Congress’s rationale for extending the $4.3 trillion 2017 corporate and individual tax cuts for ten years.
Take Action Now
To prevent this healthcare and economic calamity, North Carolinians must contact their federal legislators now. Tell them to keep ACA healthcare affordable and hospitals open by passing a ten-year extension immediately.
The window for action is rapidly closing—but decisive congressional action in the next two weeks can still prevent this crisis.
