MGMA: Ending ACA subsidies could strain health system, leave millions uninsured
The expiration of enhanced Affordable Care Act (ACA) subsidies at the end of 2025 could leave millions of Americans without health insurance and create ripple effects across the healthcare system, according to Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA). He said there also could be political implications in several Republican states.
“These enhanced subsidies allow individuals to buy insurance on the exchanges at more affordable rates,” Gilberg explained. “If they expire, the Congressional Budget Office projects several million people will become uninsured.”
The subsidies, which were expanded during the Biden administration, have played a key role in helping lower- and middle-income Americans afford coverage, particularly those in their late 50s and early 60s who are not yet eligible for Medicare. Without this support, many could face steep premium increases, forcing them to forgo insurance altogether.
Gilberg noted that the stakes extend beyond individual households, because when coverage drops, hospitals and physician practices inevitably face higher uncompensated care costs, which creates financial strain on the healthcare system as a whole.
The political dynamics around the subsidies also add complexity. Enrollment growth on ACA exchanges has been strongest in Republican-led states such as Texas, Florida, and Georgia. That puts GOP lawmakers in a difficult position, Gilberg said, as many of their constituents stand to lose coverage if subsidies are not renewed. However, Republicans have been the loudest critics of the subsidies that expanded ACA benefits.
"I think we're in for a very interesting time as we move toward the end of the year, and decisions will have to be made, especially by Republican lawmakers, whether or not they support extending those subsidies. I think the Democratic lawmakers have said that they absolutely want to keep them going. But certainly a lot of the Republican senators and members of the House of Representatives have significant members of their constituency benefiting from this, and 2026 is an election year, so I think they're going to give it a very close look before they allow it to go into effect," Gilberg explained.
Gilberg emphasized that the issue illustrates the difference between governing in the majority and opposing from the minority.
“It’s easy to criticize when you’re not in power,” he said. “But with Republicans holding the House and Senate, they could be held accountable if they allow the subsidies to lapse, that could have significant ramifications with voters who are directly affected."
For hospitals, physician practices, and patients, the coming months will be critical as Congress debates whether to extend the subsidies. Without action, the healthcare system could face a surge in uninsured patients, financial pressures on providers, and heightened political fallout heading into the next election cycle, Gilberg concluded.
For more, watch the full video interview above.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]