Today, more than 22.8 million Americans are enrolled in Affordable Care Act (ACA) plans – an insurance marketplace established in 2010 to offer affordable coverage to millions of Americans who are unable to obtain public or employer-sponsored insurance.
As a feature of the plan, federal subsidies financed by taxpayers are offered to qualifying individuals or families. As of January 20, Congress is still debating whether to extend the premium tax credits, which expired at the end of 2025 and were a driving factor behind last year's government shutdown.
A recent study led by Risha Gidwani, DrPH, an associate professor at the University of Colorado Anschutz Department of Medicine, titled “The Unaffordability of Affordable Care Act Health Insurance Plans,” provides a close examination on whether premium tax subsidies increase affordability, among other important topics related to the ACA.
“Without subsidies, we found between 68-99% of plans would be unaffordable based on premium costs for the average ACA consumer,” Gidwani says. “On the other hand, extending premium tax subsidies creates affordability problems for the individual American taxpayer, who generates most of the revenue used to fund these subsidies.”
To better understand the implications associated with extending ACA premium tax subsidies, we recently spoke with Gidwani about her findings and thoughts on what can be done to make insurance offered through the ACA more affordable.
The following interview has been edited and condensed. The opinions expressed below are the study author's and do not represent the position of the University of Colorado Anschutz.