国会预算办公室-制定选定的健康保险政策对联邦预算和健康保险人数的估计影响（英）

www.cbo.gov CONGRESSIONAL BUDGET OFFICE Phillip L. Swagel, Director U.S. Congress Washington, DC 20515 September 18, 2025 Honorable Chuck Schumer Democratic Leader United States Senate Washington, DC 20510 Honorable Jeff Merkley Ranking Member Committee on the Budget United States Senate Washington, DC 20510 Honorable Bernie Sanders Ranking Member Committee on Health, Education, Labor, and Pensions United States Senate Washington, DC 20510 Honorable Ron Wyden Ranking Member Committee on Finance United States Senate Washington, DC 20510 Re: The Estimated Effects of Enacting Selected Health Coverage Policies on the Federal Budget and on the Number of People With Health Insurance Dear Leader Schumer, Ranking Member Sanders, Ranking Member Merkley, and Ranking Member Wyden: You have asked the Congressional Budget Office for information concerning the estimated effects on federal deficits and health insurance coverage that would occur if the following changes to current law were enacted on September 30, 2025: • Permanently expand the premium tax credit structure as provided in the American Rescue Plan Act of 2021 (ARPA) and later extended through calendar year 2025 in the 2022 reconciliation act—increasing the deficit by $350 billion from 2026 to 2035 and the number of people with health insurance by 3.8 million in 2035, • Nullify a final rule published in June 2025 by the Department of Health and Human Services related to the health insurance marketplaces established by the Affordable Care Act (ACA)—increasing the deficit Honorable Chuck Schumer Honorable Bernie Sanders Honorable Jeff Merkley Honorable Ron Wyden Page 2 by $40 billion from 2026 to 2035 and the number of people with health insurance by 300,000 in 2035,1 and • Repeal sections in title VII, subtitle B, of the 2025 reconciliation act related to the health insurance marketplaces—increasing the deficit by $272 billion from 2026 to 2035 and the number of people with health insurance by 2.9 million in 2035. CBO and the staff of the Joint Committee on Taxation (JCT) estimate that each policy would increase federal deficits over the 2026–2035 period relative to CBO’s baseline projections updated to reflect administrative actions and legislation enacted through August 22, 2025 (see Table 1). CBO also estimates that each policy would increase the number of people with health insurance in each of the next 10 years (see Table 2).2 Permanently Extend the Expanded Premium Tax Credit The premium tax credit is an advanceable and refundable credit that reduces enrollees’ out-of-pocket costs for the premiums they pay for health insurance obtained through the marketplaces. The maximum credit is calculated as the difference between the benchmark premium (the premium for the second-lowest-cost silver plan available in a region) and a maximum household contribution, which is set at a percentage of household income, adjusted over time.3 1. Department of Health and Human Services,