Summary

As of January 1, enhanced Affordable Care Act (ACA) tax credits have expired, causing health insurance premiums to rise sharply for millions of people. About 22 million Americans relied on these credits to afford coverage, and many are now facing higher costs, plan changes, or the loss of insurance altogether.

Disabled people, chronically ill individuals, caregivers, and those without employer-based insurance are especially affected. Higher premiums can lead to delayed care, skipped medications, or narrowed access to specialists.

Help is still available. People who have lost coverage or can no longer afford care can turn to:

National Association of Free and Charitable Clinics (NAFC): Offers a nationwide directory of free and low-cost clinics by ZIP code.

Community Health Centers: Provide sliding-scale medical, dental, and mental health care regardless of insurance.

Medication Assistance Programs: Manufacturer patient assistance programs, prescription discount cards, and nonprofit pharmacy services can lower drug costs.

State and Local Health Programs: Medicaid, city health programs (like NYC Care), and state-based coverage options may still be available.

Enrollment Counselors and Navigators: Free, certified experts can help review options, switch plans, or check eligibility for Medicaid and other programs.

While Congress may still act to restore the credits, these resources can help people access care right now.

When the enhanced Affordable Care Act tax credits expired at the start of the year, the change was not subtle. For millions of Americans, monthly health insurance premiums rose sharply, sometimes overnight. For others, coverage that once felt stable suddenly became uncertain.

Roughly 22 million people had relied on the expanded credits to make marketplace insurance affordable. Their expiration did not just affect spreadsheets or projections; it landed in kitchens, pharmacies, and doctors’ offices across the country.

For disabled people, the consequences are especially immediate. Many rely on the ACA marketplace because they are self-employed, work part time, or cannot access employer-sponsored insurance. At the same time, they often need consistent medical care, prescriptions, and access to specialists. When premiums spike, care is not simply postponed — it is rationed.

Some people are switching to cheaper plans with narrower networks. Others are delaying appointments or cutting pills in half. A growing number are confronting the possibility of being uninsured, at least temporarily.

Where to Turn If Coverage Is Lost or Unaffordable

The loss of subsidies does not mean the loss of all care. For people navigating higher costs right now, several resources can help bridge gaps:

Free and low-cost community clinics.
The National Association of Free and Charitable Clinics (NAFC) supports a nationwide network of free and charitable clinics that provide primary care, chronic disease management, mental health services, and, in some cases, prescription assistance — regardless of insurance status.

Through the NAFC’s website, individuals can search by ZIP code to find nearby clinics, review eligibility requirements, and learn what services are offered. These clinics are often staffed by volunteer physicians, nurses, and pharmacists and can be a critical lifeline during coverage disruptions.

Medication assistance programs.
Many pharmaceutical companies offer patient assistance programs that provide free or reduced-cost medications for people who are uninsured or underinsured. Healthcare providers and community clinics can often help patients apply.

State and local health programs.
Some states offer Basic Health Programs, supplemental subsidies, or temporary coverage options. Medicaid eligibility may also change with income fluctuations, particularly for people whose work is seasonal or contract-based.

Enrollment counseling.
Certified ACA navigators and assisters — often based at nonprofit organizations or community health centers — can help people reassess marketplace options, switch plans, or determine whether they newly qualify for Medicaid or other assistance.

A Moment of Instability — and of Urgency

Congress may still act to restore or extend the credits, but for now, millions are left managing uncertainty in real time. Health insurance, unlike many expenses, is not easily deferred. Gaps in care can quickly become crises, especially for disabled and chronically ill people.

Losing affordable coverage should not mean losing care — and it should not happen quietly.

The credits have expired. The need has not.