Of the roughly 24 million people who get their health insurance through the ACA Marketplace, a vast majority benefit from the premium subsidies.
Stacy Cox, a photographer in Utah, has saved over $10,000 a year on average since she started benefiting from the subsidies in 2022.
“It is an absolute lifeline for so many of us,” said Ms Cox, who has an autoimmune disease.
But if the tax credits are not extended, Ms Cox said she will have to quit her newly launched photography business and find a different job that provides health insurance.
Around seven million people like Ms Cox are expected to stop buying health insurance through the marketplace if the tax credits end, Ku said. Of those, around four to five million are expected to lose health care coverage altogether because they won’t be able to find other means, data suggests.
Many of those who will be affected are working-class people who don’t qualify for Medicaid, the government-run programme which provides healthcare insurance for low-income adults, children, pregnant women, elderly adults and people with disabilities.
The hardest hit could be those in 10 US states – most of which vote Republican – that have chosen not to expand eligibility for Medicaid.
“One of the political paradoxes of all this is that the places that get hurt the most are states that are more conservative,” said Ku.
If the subsidies expire and healthier people begin to opt out of insurance, that will also raise premium prices overall for Americans, as a sicker pool of customers will drive up healthcare costs, said Elizabeth Fowler, a distinguished scholar at Johns Hopkins Bloomberg School of Public Health.
“You start to get into a death spiral where premiums become even more expensive and more out of reach for more people,” she said.