Virginia Business, Health Care Leaders Press for Renewal of ACA Tax Credits

As she approaches her final year of grad school to eventually become a school counselor, Richmond-area resident Natalie Tyer is stressed about whether or not she will be able to afford health care next year. Special tax credits that help people like her purchase health insurance plans will lapse in December without action from Congress, a prospect federal lawmakers are currently debating.

From left to right: Chamber RVA president Brian Anderson moderates a panel with small business owner Ron Carey, and hospital administrators Lance Jones and Michael Elliott to discuss the role of special tax credits that help workers purchase health insurance plans in the ACA marketplace. (Photo by Charlotte Rene Woods/Virginia Mercury)

As a part-time employee at Hit Play, an event technology company, and a singer-songwriter who performs gigs, a good chunk of Tyer’s time is focused on finishing school. By next year, she’lll have to work even less while she fulfills a series of required practical internships to earn the degree. Purchasing health insurance through Virginia’s marketplace and utilizing the special tax credits to offset some of the cost buys Tyer peace of mind, but now she’s facing the reality that she might have to forgo renewing her plan, which would leave her unprepared in case of any medical emergencies next year.

“I may have to just rely on a strategy of hope until I finish grad school and I get a job in the public school system and hopefully get those benefits,” she said.

About 400,000 Virginians purchase health insurance through the state’s exchange, and some of those people, like Tyer, qualify for and use the enhanced premium tax credits. First created in 2021 and extended in 2022, they’re set to expire at the end of this year unless Congress renews them.

The credits are meant to apply to people that earn between 100% and 400% of the federal poverty level.

Money is tight for Tyer as she pursues her dream job and the credentials it requires, she said at a ChamberRVA panel discussion on Wednesday, and the soon-expiring tax credits add to her concerns as a future public servant.

“It’s frustrating because this doesn’t encourage people to go into fields like education where we’re needed,” she said. “There’s a teacher shortage, there’s always a need for school counselors.”

At Wednesday’s panel, health care professionals and small business owners discussed how federal health care policy can affect Virginia’s business communities and public health.

Panelist Ron Carey shared his insights as the CEO of Tilt Creative + Production, a media and marketing company. While he’s able to provide insurance to his full-time staff of about 55 people, his company regularly works with freelancers throughout the year.

By his estimates, that’s anywhere from 10 to 15 people, but when there are larger projects the company is hired for, that number can balloon to 50 or more freelancers. It’s these workers that he is worried about.

Carey described the forthcoming changes to Medicaid and hospital funding mechanisms, as well as possibility of enhanced premium tax credits not being renewed, as “a bit of a tsunami.”

“It’s far out right now, but you can see the horizon on the water,” he said in an interview with the Mercury prior to the event. “As it starts to come closer to the shore and these things start to take effect, all of the sudden we’re going to see a crescendo of consequences.”

Certain Aetna health insurance plans leaving the Affordable Care Act marketplace next year

Some of the consequences are already salient. Aetna plans to withdraw from the ACA marketplace by the end of this year. The Mercury asked if the uncertainty of enhanced premium tax credits’ fate were a factor, but Aetna representatives neither confirmed nor denied.

Virginia Health Benefit Exchange director Keven Patchett told state lawmakers last week that an estimated 100,000 Virginians could fall off their insurance due to the cost. He also estimated that out-of-pocket premiums could rise 30% to 50% in January of next year.

The Bureau of Insurance also plans to provide presentations on proposed average changes to rates “as submitted by carriers” for 2026 that will be posted to the State Corporation Commission’s website on Aug. 7.

Nationwide, an 18% median increase is estimated for marketplace plan costs next year, according to the Peterson-KFF Health System Tracker.

In the meantime, business communities, health care professionals and patients that rely on the tax credits should  reach out to federal lawmakers in the coming months to ask questions and share their worries, Chamber RVA president Brian Anderson said.

“It’s not something that might go away — it’s scheduled to go away,” Anderson said. “We gotta make sure we get the message out that we want (to keep these credits).”

VCU Health COO Michael Elliott and Chippenham Hospital CEO Lance Jones shared their perspectives on the panel as administrators at health systems. Both anticipate a future with more emergency room visits by patients who put off care because they had to choose between paying rent or paying a higher insurance premium.

Elliott noted the “stacking effect” of health care changes in Congress’ reconciliation bill that President Donald Trump signed into law last month.

That law, dubbed the “One Big Beautiful Bill Act” entails forthcoming changes to Medicaid that could result in fewer beneficiaries and adjustments to hospital funding mechanisms. Over time, this will force hospitals to make critical choices  — to either trim certain services and staff, or raise rates when negotiating with private health insurers, Elliott and Jones said.

“We’re always doing contingency planning for sure,” Elliott said. “This is a time frame in which there are a lot of things starting to stack up. And so our plan is getting much deeper, and hopefully that won’t lead to actions and decreased services. But I imagine in some places … it could.”

Could uncertainty over ACA tax credits spur a special legislative session?

U.S. Rep. Jennifer McClellan, D-Richmond plans to stay in conversation with her colleagues about the matter. She’s a co-sponsor of a bill that would make the tax credits permanent. Introduced earlier this year, it has yet to advance. And while Congress did not take action on the credits as part of the reconciliation bill, it could still do so.

“With open enrollment coming, we really need to act quickly,” she said.

State lawmakers are also keeping a watchful eye on whether Virginia’s legislature might have a special session over the tax credits or how much of its 2026 legislative session may need to focus on health care.

“We know there’s going to be gaps in our budget around health care significantly, but on so many other levels,” Sen. Ghazala Hashmi, D-Chesterfield, said.

Hashmi, who is running for lieutenant governor, could address these matters when presiding over the state senate should she win, or, if she doesn’t, from retaining her seat within the chamber and her chair role of its health committee.

“Filling those gaps is going to be an important part of the conversation about what we can do at the state level,” she said.

by Charlotte Rene Woods, Virginia Mercury

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