New letter pushes for immediate action as end-of-year expiration looms, threatening the health care of 22 million Americans
Washington, D.C.— Today, Allentown Mayor Matt Tuerk, Chair of the U.S. Conference of Mayors’ (USCM) Children, Health, and Human Services Committee, and USCM CEO and Executive Director Tom Cochran called on congressional leaders to urgently extend the Affordable Care Act (ACA) enhanced premium tax credits, which expire in just weeks. Skyrocketing health care costs threaten Americans’ ability to afford their coverage and would place incredible strain on local governments, hospitals and economies.
In a letter to Speaker of the House Mike Johnson, House Majority Leader Steve Scalise, House Minority Leader Hakeem Jeffries, Senate Majority Leader John Thune and Senate Minority Leader Chuck Schumer, USCM cautions that without action by December 31, 2025, nearly 5 million Americans will lose health insurance coverage due to unaffordable premiums, and millions more will pay significantly more for coverage. The letter also stresses the negative impacts an expiration of the credits would have on the local level.
The letter reads in part:
For mayors, this is not an abstract policy debate. We observe the direct impact on our constituents, municipal health systems, safety-net hospitals, and local economies. As uninsured rates rise, our city governments, hospitals, community health centers, and emergency departments will bear the costs of unpaid care. It is estimated that these costs will rise by $7.7 billion in 2026. Moreover, safety‑net providers and rural hospitals would face significant revenue shortfalls (estimated at more than $30 billion nationally in 2026), increasing the risk of service cutbacks, closures, and reduced access to essential services. Municipal budgets are already stretched thin; cities simply cannot absorb millions of dollars in unpaid emergency care.
The full text of the letter can be found below and a copy is linked here.
Friday, December 5, 2025
The Honorable Mike Johnson
Speaker of the House
U.S. House of Representatives
Washington, DC 20515
The Honorable Steve Scalise
Majority Leader
U.S. House of Representatives
Washington, DC 20515
The Honorable Hakeem Jeffries
Minority Leader
U.S. House of Representatives
Washington, DC 20515
The Honorable John Thune
Majority Leader
United States Senate
Washington, DC 20510
The Honorable Charles Schumer
Minority Leader
United States Senate
Washington, DC 20510
Urgent Action Needed to Extend Affordable Care Act Premium Tax Credits
Dear Speaker Johnson, Leader Scalise, Leader Jeffries, Leader Thune, and Leader Schumer:
On behalf of The United States Conference of Mayors, we are writing to urge immediate action to extend the Affordable Care Act (ACA) enhanced premium tax credits before they expire on December 31, 2025. Failing to act will have serious consequences for millions of American families and the economic health of our cities and towns.
We are gravely concerned that allowing the enhanced premium tax credits to expire will cause an unprecedented health care affordability crisis in communities nationwide. According to the Kaiser Family Foundation, if Congress does not act by December 31, 2025, nearly 5 million Americans will lose health insurance coverage due to unaffordable premiums. The expected impact is that the average annual health insurance premiums for subsidized enrollees will more than double, increasing by 114%—from approximately $888 in 2025 to $1,904 in 2026.
For mayors, this is not an abstract policy debate. We observe the direct impact on our constituents, municipal health systems, safety-net hospitals, and local economies. As uninsured rates rise, our city governments, hospitals, community health centers, and emergency departments will bear the costs of unpaid care. It is estimated that these costs will rise by $7.7 billion in 2026. Moreover, safety‑net providers and rural hospitals would face significant revenue shortfalls (estimated at more than $30 billion nationally in 2026), increasing the risk of service cutbacks, closures, and reduced access to essential services. Municipal budgets are already stretched thin; cities simply cannot absorb millions of dollars in unpaid emergency care.
Additionally, we know all too well that the stress of losing health coverage—and the inability to access preventive and mental health services—will worsen depression, anxiety, and substance abuse in our communities.
Health coverage is not a luxury—it is a necessity. Families in our cities are already facing an affordability crisis as housing, utility and food costs rise and wages remain stagnant. If the tax credits are not extended, many of our residents will be forced to choose between paying for health insurance or paying for rent and other necessities.
The nation’s mayors urge Congress to pass legislation to extend the enhanced premium tax credits before year-end. We stand ready to assist Congressional leaders and support bipartisan solutions that protect health care access for millions of Americans.
Thank you for your immediate attention to this critical issue.
Respectfully,
Matt Tuerk, Mayor, City of Allentown, USCM Chair, Children Health and Human Services
Tom Cochran, CEO and Executive Director, U.S. Conference of Mayors
Cc:
Senate Committee on Finance
House Committee on Ways and Means
House Committee on Energy and Commerce