From funding cuts to policy reforms, the Republican-passed reconciliation bill (H.R. 1) directly harms seniors, including by making health care and insurance less available and more expensive. As the fate of the expiring Affordable Care Act (ACA) tax credits remains uncertain, we look forward to the latest KFF analysis to learn more about how HR 1's interaction with the ACA will affect adults age 50 and older.
The impact of HR 1 on the ACA market
HR 1 makes changes to the ACA marketplace that will increase the number of uninsured people and premium costs.
Admissions changes
Combined with the Trump administration's marketplace integrity rules, the new law will make it more difficult to enroll in marketplace programs, in part by shortening enrollment times and creating onerous administrative requirements. As many as 3 million people, including seniors, are expected to lose health insurance as a result.
premium tax credit
The law also fails to renew premium tax credits that expire this year. Since 2012, ACA tax credits have helped low- and moderate-income people pay Marketplace premiums. In 2021, the American Rescue Plan Act (ARPA) increased the amount and availability of credit, and in 2022 the Inflation Reduction Act (IRA) delayed the expiration of the credit, but only through the end of 2025.
This assistance enabled millions of adults ages 50 to 64 to purchase insurance, resulting in a 50% drop in the uninsured rate for this group.
Today, the enhanced credit line makes ACA Marketplace plans less affordable for more than 22 million people, including many seniors who are not yet eligible for Medicare. These credits reduce enrollee premiums by an average of $705 per year. This assistance has enabled millions of adults ages 50 to 64 to purchase insurance, reducing the uninsured rate for this group by 50% while helping to increase overall Marketplace enrollment from 12 million in 2021 to a record 24.2 million in 2025.
Older people face significant risks
If the enhanced tax credit lapses, Marketplace participants with incomes above 400% of the poverty level ($84,600 for a family of two in 2025) will lose all assistance, while those with incomes between 100% ($21,000 for a family of two) and 400% of the poverty level will receive even less support.
Older people have been particularly hard hit. More than half of the enrollees who will have their subsidies removed are between the ages of 50 and 64. They will bear the entire premium, which is expected to increase by at least 18% in 2026, although some may see higher increases. These enrollees are already at a cost disadvantage: Under the ACA, insurers can charge people in their 50s and 60s higher premiums than younger people buying the same plans in the same area.
Under the Affordable Care Act, insurance companies can charge people in their 50s and 60s higher premiums than younger people buying the same plan in the same area.
As the KFF example shows, the impact will be severe: If Congress extends the Enhanced Premium Tax Credit before the end of this year, a 59-year-old single widow earning $63,000 a year (just above 400% of the poverty level, $62,600 for an individual) would pay $5,355 for her silver market plan in 2026. But if the points expire, she could pay more than twice as much for the exact same health insurance policy—$14,213 in premiums, or almost 23 percent of her income.
what's the danger
If the enhancements expire, nearly all (92%) of the 5.2 million adults aged 50 to 64 will face higher costs next year. Analysis shows that insured persons' premiums will rise by an average of 75%, while those in rural areas may see premiums rise by 90%.
While some people may be able to find alternative coverage, millions cannot. The resulting loss of coverage will mean reduced access to care, worsened individual health outcomes, and higher Medicare costs because more people will join the plan in poorer health and require more expensive interventions than they would otherwise.
The loss of coverage will mean higher Medicare costs as more people join the plan in poorer health and require more expensive interventions.
Across all age groups, at least 4.2 million people are expected to remain uninsured unless Congress takes action.
Congress must act quickly
At Medicare Rights, we will continue to work to protect the benefits of ACA coverage. People must have access to high-quality, affordable health care and insurance. To this end, we urge lawmakers to immediately extend the enhanced credit. Otherwise, people may have no choice but to abandon their marketplace plans, resulting in harmful coverage losses that could harm personal health and financial security as well as the sustainability of health insurance.
Read the KFF report What do the health-related provisions in the settlement law mean for seniors? 》
