With health care subsidies expiring in the new year, Cook County Health officials and political leaders on Wednesday warned the impact will not only hurt millions of Americans but also affect the county’s bottom line and hospitals around the state.
Congress remains at a stalemate over the future of subsidies for certain households that buy insurance through the Affordable Care Act marketplace. During the pandemic, Congress expanded eligibility for those subsidies and boosted the tax credit but only through the end of 2025. Millions took advantage at the time and now, with the subsidies expiring, they face the risk of seeing their premiums double without federal help, the local officials warned.
Congressional Democrats prolonged the government shutdown to extend those premium tax credits but failed to secure it. A bipartisan group of House members filed a discharge petition to force a vote on the issue in early January, but Senate Republicans have opposed extending it without changes to reduce the cost to the federal government.
The Congressional Budget Office estimates a simple extension would cost more than $100 billion annually.
But Cook County Board President Toni Preckwinkle, who joined CCH medical leaders and U.S. Rep. Raja Krishnamoorthi at a news conference in the John H. Stroger Hospital Professional Building on Wednesday, warned the cost “would be immediate and personal.”
The expiration will result in “higher premiums, lost coverage, delayed care and growing anxiety about what happens when someone gets sick,” Preckwinkle said. “In Cook County, we know exactly who bears the brunt of these cuts: working families, seniors on fixed incomes, people managing chronic conditions, and communities that have already faced too many barriers to care.”
Average monthly ACA premiums are projected to roughly double, Krishnamoorthi, one of three Democratic candidates for U.S. Senate, said. Of the 360,000 Cook County residents who rely on ACA coverage, 90% of them “depend on these tax credits to afford their coverage.”
Premium tax cuts will remain available for a subset of people, but the level of support will decrease for most. Anyone earning more than 400% of the federal poverty level — or around $63,000 per year for a single person — won’t be eligible for the remaining tax credits.
“Some will need to choose between food on their table and seeing a doctor, or getting a mammogram or a blood test,” said Donnica Austin-Cathey, Stroger’s chief hospital executive. “Some will need to choose between diabetes medication or paying their rent.”
The Affordable Care Act fundamentally changed CCH: more patients were insured and received preventive care, resulting in fewer visits to emergency rooms for expensive chronic conditions. CCH’s mission has been to treat all patients regardless of their ability to pay. That has meant many patients were treated on the county’s dime.
But the ACA allowed CCH to receive payments for insured care and also opened the door to the county running its own Medicaid managed care program, CountyCare, which separately bolstered its budget.
The expiration of those premium subsidies, combined with changes to Medicaid that were part of President Donald Trump’s Big Beautiful Bill Act, will partially reverse that, officials said. Hospitals across the state may see more uninsured patients coming to emergency rooms with critical health problems that are more expensive to treat than if patients had had preventive and regular care.
“These costs will not disappear. They are pushed onto hospitals, counties and ultimately, taxpayers,” Krishnamoorthi said.
CCH projects charity care will rise from a pandemic low of $134 million in 2022 to $380 million in 2026.
Preckwinkle said Cook County will continue to welcome all patients and is expanding its outreach “so residents can understand their options, maintain coverage where possible, and transition into CountyCare or other programs when federal support falls away,” and said the county has some reserves to weather the fiscal storm.
Krishnamoorthi said he expects the discharge petition to pass the U.S. House next week.
“At that point, I think the pressure will be on” the Senate to act, he said.
If the Senate approves a deal, he said it is not too late to apply the credits retroactively — but that those who have opted out of insurance coverage entirely because of the cost may be out of luck. In the meantime, he said, “insurance companies absolutely should do whatever it takes to kind of tide people over for as long as they can.”