The health organization sounds the alarm on expiring health insurance subsidies—and the ripple effects for those managing chronic disease.
As 2025 comes to a close, millions of Americans could be heading into the new year without affordable health insurance due to the expiration of enhanced health insurance subsidies under the Affordable Care Act (ACA). And now, the American Heart Association (AHA) is warning that these changes could trigger steep premium increases, major coverage losses, and serious health risks for at least nine different groups of people.
During the evening of Wednesday, December 17, the U.S. House of Representatives passed a Republican-backed bill “that would not address expiring Affordable Care Act tax credits, all but guaranteeing the enhanced subsidies will lapse at the end of the year,” according to Politico, which reports the bill will be “dead on arrival” in the U.S. Senate.
In a December 16, 2025 news release, the American Health Association said it is “deeply disheartened” with the U.S. Congress for failing to act to extend the subsidies. Enhanced premium tax credits were first expanded during the COVID-19 pandemic in 2021 to make ACA marketplace plans more affordable for people and families, according to Harvard experts. Those credits have helped keep out-of-pocket insurance costs down. But with Congress failing to extend the program, those financial supports will lapse at the end of the year.
Without the subsidies, millions of people’s health coverage is about to get more expensive, which may cause them to go without coverage completely—meaning that for many, chronic disease management will be impacted. “Allowing these credits to expire will have immediate and harmful consequences on people’s ability to prevent, manage, and treat chronic disease,” said Nancy Brown, CEO of the American Heart Association. “Premiums will sharply rise, and according to estimates, up to 4 million people could lose their insurance.”
Brown specifically notes at least 9 groups of people who will be disproportionately affected by rising health care costs. These include people living with the following conditions:
- Heart disease
- Stroke
- Hypertension
- Diabetes
Beyond those with certain health conditions, higher health insurance premiums will also be “especially severe” for the following groups, who typically have to purchase their own health coverage:
- Small business owners
- Gig workers
- Farmers
- Early retirees
- Those with other serious chronic conditions who cannot rely on employer-based coverage
“Losing coverage is not a minor disruption—it is an economic burden and direct threat to their health and well-being,” said Brown. “Families will face higher costs, may delay treatment, and be forced to make impossible choices between health care and basic needs such as healthy food, housing, and utilities.”
Heart disease is the leading cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC), costing an estimated $252.2 billion between 2019 and 2020 to treat. The American Heart Association is urging lawmakers to reconsider their decision and prioritize extending the tax credits, calling access to affordable coverage essential to public health and chronic disease management.
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