Without Renewal of Enhanced Premium Tax Credits, Rural Hospital Revenues Will Drop by $1.6 Billion

Commonwealth Fund November 13, 2025
Randy Haught, Allen Dobson, Collin McGuire, Akeiisa Coleman

TOPLINES

The expiration of the ACA’s enhanced premium tax credits will hurt rural hospitals — revenues will decline by $1.6 billion and operating margins will fall by more than 10 percent in 2026

Rural hospitals in states that did not expand Medicaid under the Affordable Care Act would be hardest hit

Enhanced premium tax credits (PTCs), which were established to lower premiums and make health insurance more affordable for people enrolled in marketplace plans, are set to expire at the end of 2025. Congress is considering whether to make them permanent, extend them with or without structural changes, or allow them to expire

A recent study by the Urban Institute estimated that allowing the enhanced PTCs to expire would cause...

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