View original post on NJ.com, November 9, 2025
By Shamik Bhat and Soumitra S. Bhuyan
As Washington grinds through the longest shutdown in history, New Jersey families are monitoring an upcoming crisis at home: upcoming expiration of enhanced Affordable Care Act subsidies on New Jersey’s marketplace threatens to raise healthcare costs for hundreds of thousands.
These subsidies — delivered as premium tax credits (PTCs) based on income — have been a consequential health policy success.
First made available in 2014 through the Health Insurance Marketplace established by Affordable Care Act of 2010, they lower premiums and cap them based on a household’s income, expanding coverage to millions of middle-income Americans who would otherwise remain uninsured. Credits were expanded in the American Rescue Plan Act (ARPA) in 2021 and were further extended in the Inflation Reduction Act (IRA) in 2022.
New Jersey built on this federal progress: the state layers its own subsidies, NJ Health Plan Savings, on top of federal tax credits to drive premiums even lower for low and middle-income families. Enrollment in New Jersey’s marketplace, GetCoveredNJ, rose dramatically in response, doubling from 269,000 in 2021 to 513,000 today.
Yet unless Congress acts, these subsidies will expire at the end of the year. Millions nationwide will face dramatic spikes in costs—with premiums estimated to double without subsidies—or lose coverage altogether.
The Congressional Budget Office has estimated nearly 4 million Americans will lose health insurance through 2034 if subsidies are not extended, and this comes at a time when insurers in many states are projecting dramatic increases in premiums regardless of subsidies.
Families across New Jersey are already struggling with rising costs from groceries to housing. Congress must not walk away from the progress made in recent years; millions of lives are at risk.
Stakes are high for patients and families
If Congress does not act, the implications are staggering. Early retirees in South Jersey will struggle to afford care until they qualify for Medicare. Small-business owners in high-cost counties, including Bergen, Hudson, and Monmouth, may be forced to close operations. Part-time municipal workers and teachers may lose life-saving primary care they could finally afford in recent years.
Expanded PTCs during the COVID-19 public health emergency likely saved thousands of lives in lower-income Newark, Trenton and Camden, where subsidies often allowed for $0 premiums. Families would now be forced to choose between maintaining coverage or paying rent and bills.
In a state with the highest property taxes in the nation, households are already facing tight budgets; drastic increases in health insurance costs could lead to financial ruin.
The consequences go beyond households. New Jersey hospitals would incur billions of dollars of additional costs in uncompensated care and insurers would likely face an older, sicker risk pool. Both would result in higher premiums for all Americans, and states would be forced to find additional funding to support newly uninsured residents turning to emergency care in hospitals.
New Jersey’s safe-net hospitals — from University Hospital in Newark to Cooper Hospital in Camden — already carry a disproportionate share of uncompensated care. If thousands of enrollees price out of coverage, these invaluable hospitals will see more unpaid bills, commercial premiums will rise, and the state’s charity-care program will face renewed pressure.
Some lawmakers have opposed extending expanded subsidies to concern over costs; the Congressional Budget Office expects subsidies to cost the federal government $350 billion over the next ten years. These concerns simply miss the larger economic picture.
Letting millions lose coverage will not make costs disappear; it will simply shift them to hospitals, states, and taxpayers paying for higher uncompensated and emergency care.
Subsidies are an investment in New Jersey: insured residents stay healthier, drive down emergency costs, and can fully participate in the economy. Coverage stabilizes insurance markets, preventing the price spikes we are starting to see; these spies ripple across the private sector.
The federal government must continue its responsibility to invest in Americans and their health; it is an economic and moral failing to abandon this duty.
The clock is running
Timing is crucial — open enrollment for 2026 plans have begun this week.
This is especially important in New Jersey, where the state marketplace allows for open enrollment beyond the traditional federal window. State regulators across the nation have warned that if Congress delays further action, it could be too late to prevent chaos in insurance markets.
Even if lawmakers reauthorize subsidies now, some consumers will face higher costs from uncertainty among insurers. In an already fragile economy, this uncertainty increases costs for insurers and consumers, and further erodes Americans’ trust in government and health care.
Short-term extensions and debates with Americans’ health care held hostage only encourage this cynicism. A multi-year or permanent extension sends a clear signal: access to affordable coverage is not negotiable and Americans can depend on marketplaces to ensure their family has affordable access to care.
There is certainly room for thoughtful debate about the structure of subsidies. Congress could tweak eligibility thresholds or pair the extension with measures that try to address underlying medical costs.
These negotiations can take place when time is not critically running out; letting subsidies lapse would deliberately disrupt the Affordable Care Act, throwing potential future reforms in jeopardy.
Public sentiment is also clear on this front: nearly 80% of Americans support extending ACA subsidies, and many are still unaware that they may face higher costs if Congress fails to do so. At a moment when Washington seems incapable of agreement and in the midst of a government shutdown, preserving affordable coverage for millions of Americans could be a rare, bipartisan win.
Congress must act
The Affordable Care Act drastically improved the American health care system.
New Jersey worked to build on this work, adding additional state subsidies and ensuring insurer pool stability with a state-level individual market. Now, the federal government threatens to pull the rug from under New Jersey and its residents, penalizing the state for investing in its residents’ health.
As the government shutdown continues, Congress faces a simple choice: it can allow the country’s health care safety net to collapse, or it can reaffirm its commitment to protecting the most vulnerable among us.
New Jersey has spent years building a promise: all its residents should have access to affordable healthcare, regardless of income or zip code. That promise depends on Congress extending the Affordable Care Act’s enhanced subsidies. Letting them lapse is not just a policy decision; it is a moral one. In a moment of national uncertainty, lawmakers must remember that stability in health care is stability in people’s lives.
Nearly half a million New Jerseyans are counting on them to maintain that lifeline.