Jeff Roe: Congress must extend enhanced ACA premium tax credits before families are priced out

Congress has a choice: Protect affordable health care for millions of Americans or stand by as premiums double and families lose coverage. The clock is ticking.

The enhanced premium tax credits under the Affordable Care Act, first expanded in 2021 and extended through 2025, have been a lifeline for working families, small business owners, and gig workers. Without them, affordability collapses.

Here in Washington, the Washington Health Benefit Exchange estimates that 80,000 people could lose coverage if the credits expire. Those who keep coverage could see premiums rise by an average of 65 percent. Families already stretched by inflation will face impossible choices: groceries or health care, rent or prescriptions.

Nationally, Keep Americans Covered predicts that if the tax credits expire, a typical family of four making $125,000 would see their health care premiums increase by $7,700. For a 60-year-old couple with an income of $80,000, premiums would skyrocket by $17,500. For a family of four making $64,000, it would be a $2,600. That is not sustainable for working households in any community.

This is not an abstract policy debate. It is about parents who need coverage for their children, small business owners depending on ACA plans for their employees, and young people who need to start their adult lives with health insurance.

When coverage becomes unaffordable, people delay preventive care, skip medications and end up in emergency rooms with higher-cost needs. Those costs do not vanish. They ripple across the system impacting everyone else in the form of higher hospital bills, local taxes, and insurance premiums.

Employers might assume this debate does not affect them and their employees, but it does. When doctors and hospitals take on more uncompensated care, those expenses shift to commercial insurance, and employers bear that cost in higher premiums. If you’re among Washington’s nearly 4 million residents insured through your employer, you might assume you’re immune from this struggle. You’re not. Extending the enhanced premium tax credits is essential to keep the marketplace stable. Without them, costs will land back on the very employers and workers already carrying the heaviest load, and that’s a price none of us should have to pay.

As a local not-for-profit health plan, Premera sees every day how affordability affects families and employers across Washington, and why extending these tax credits matter for the people and communities we serve.

Affordable individual coverage also gives employees freedom to change jobs, start businesses, or join the gig economy. Without it, more workers stay locked in jobs just for the benefits, stifling innovation and slowing economic growth. Health care affordability is not only a family issue. It is also about keeping Washington businesses competitive and our economy strong

Congress cannot wait until the last minute. Health plans have already filed 2026 rates. Employers are building next year’s benefit budgets. Families are trying to plan their lives. Every week of delay creates more uncertainty and higher costs.

Washington’s business and civic leaders must act. Contact Congress. Speak out through chambers, trade groups, and local networks. Health care affordability isn’t optional; it’s the backbone of a strong economy

To Congress: Extend and stabilize the enhanced ACA premium tax credits before families are priced out. This is not about politics. It is about protecting people, preserving affordability, and supporting economic growth.

The decision is clear. The time to act is now.

Jeff Roe, of Seattle, is president and CEO of Premera Blue Cross, a not-for-profit health plan based in Mountlake Terrance, Washington, and with offices in Spokane.