Failing To Extend ACA Premium Tax Credits Is An Attack On Black Working-Class Families

By Economic Policy Institute Photos: YouTube Screenshots At a time when working-class families are already facing a weakened job market, high prices, and general economic uncertainty due to erratic federal policy, Republicans in Congress seem committed to worsening their economic anxieties. The enhanced ACA premium tax credits, instituted with the American Rescue Plan (ARPA) and extended through the Inflation Reduction Act (IRA), were not extended through the Republican-led reconciliation budget. These credits have led to the largest increase in health insurance coverage since the ACA’s Medicaid expansion, and saved enrollees on average $705 annually in 2024. Working-class families across the country will feel the implications of this policy failure as health insurance premiums rise (Groundwork Collaborative 2025). However, Black families, who face higher rates of poverty and uninsurance even under “normal” circumstances, are positioned to be hit especially hard by the loss of the enhanced subsidies. The loss of the premium tax credits is also set to economically drain the cities where lots of Black families live, especially those cities in states that neglected to expand health coverage through the ACA (Ortaliza 2025). This analysis will focus on 10 major metro areas: Atlanta, Chicago, Dallas, Detroit, Houston, Los Angeles, Miami, New York, Philadelphia, and Washington, D.C. Impact on Black families across 10 major metro areas The Affordable Care Act, largely through its Medicaid expansion in 2014, set in motion a decade-long trend of falling rates of uninsurance throughout the country (Ortaliza, McGough, and Cox 2025; Hill et al. 2025). However, some states, particularly those throughout the South where the majority of Black Americans live and work, refused to expand Medicaid through the ACA (Childers 2023). Southern states’ refusal to expand access to Medicaid has meant lower coverage rates in those states and that a large share of Black Americans fall into what is known as the health insurance “coverage gap”; that is, they qualify for neither Medicaid nor traditional ACA subsidies (Lukens and Harker 2024). Even outside the coverage gap, many individuals who do qualify for ACA subsidies remain uninsured due to cost and enrollment difficulties. The enhanced ACA premium tax credits do not eliminate racial disparities in health insurance coverage, nor do they close the coverage gap faced by Black Americans. However, the tax credits do make insurance more affordable, and thus practically more accessible, for those individuals who qualify. This increase in accessibility has led to the largest increase in Marketplace enrollment since the Medicaid expansion, with outsized increases among low-income individuals and in states that did not expand Medicaid. The loss of the tax credits would reverse hard-won progress made in reducing racial disparities in uninsurance rates (Buettgens et al. 2025). Table 1 Number of uninsured Black residents before enhanced ACA tax credit expiration, and percent increase in uninsured Black residents after credit expiration, by Metropolitan Statistical Area (MSA) MSANumber of uninsured Black residentsBlack participants newly losing coveragePercent increase in uninsured Black residentsAtlanta-Sandy Springs-Roswell, GA179,30440,82323%Chicago-Naperville-Elgin, IL-IN78,7776,8969%Dallas-Fort Worth-Arlington, TX151,20631,59921%Detroit-Warren-Dearborn, MI43,1992,9977%Houston-Pasadena-The Woodlands, TX165,24939,47424%Los Angeles-Long Beach-Anaheim, CA39,2003,2618%Miami-Fort Lauderdale-West Palm Beach, FL89,68814,25316%New York-Newark-Jersey City, NY-NJ148,32912,4758%Philadelphia-Camden-Wilmington, PA-NJ-DE-MD66,62613,86621%Washington-Arlington-Alexandria, DC-VA-MD-WV57,6578,01714% READ MORE