The ACA provides low- and middle-income individuals with premium tax credits to purchase health coverage on the exchange. Originally authorized by the American Rescue Plan Act in 2021, enhanced PTCs were later extended by the Inflation Reduction Act. Without another congressional extension, the PTCs will expire at the end of 2025.
As of January 2025, 24 million people are enrolled in an exchange plan. Without a PTC extension, an estimated 4 million people will become uninsured, creating a ripple effect across the healthcare industry and wider economy. Overall employment would decline by a total of 286,000 jobs nationwide in 2026, including 130,000 jobs lost in healthcare at hospitals, physician offices, and other ambulatory care and pharmacies.
“It should be noted that our estimates are conservative,” Commonwealth Fund researchers wrote. “They do not account for the potential loss of productivity likely to result when people who lose access to affordable insurance, and thus affordable medical care, are unable to work because of a decline in their health status.”
States ranked by healthcare job losses in 2026 if premium tax credits expire:
Texas
Healthcare job losses: 30,800
Total jobs lost: 69,300
Florida
Healthcare job losses: 22,100
Total jobs lost: 49,200
Georgia
Healthcare job losses: 12,800
Total jobs lost: 28,400
Tennessee
Healthcare job losses: 5,800
Total jobs lost: 13,300
Louisiana
Healthcare job losses: 5,200
Total jobs lost: 11,300
South Carolina
Healthcare job losses: 5,000
Total jobs lost: 10,900
Alabama
Healthcare job losses: 4,500
Total jobs lost: 10,000
Mississippi
Healthcare job losses: 4,000
Total jobs lost: 8,500
Ohio
Healthcare job losses: 3,500
Total jobs lost: 7,800
California
Healthcare job losses: 3,100
Total jobs lost: 6,600
North Carolina
Healthcare job losses: 2,500
Total jobs lost: 5,300
Arizona
Healthcare job losses: 2,400
Total jobs lost: 5,300
New York
Healthcare job losses: 2,200
Total jobs lost: 4,400
Indiana
Healthcare job losses: 2,100
Total jobs lost: 4,600
New Jersey
Healthcare job losses: 2,000
Total jobs lost: 4,100
Kentucky
Healthcare job losses: 2,000
Total jobs lost: 4,300
Missouri
Healthcare job losses: 1,600
Total jobs lost: 3,700
Kansas
Healthcare job losses: 1,600
Total jobs lost: 3,500
Arkansas
Healthcare job losses: 1,600
Total jobs lost: 3,300
Oklahoma
Healthcare job losses: 1,700
Total jobs lost: 3,700
Utah
Healthcare job losses: 1,400
Total jobs lost: 3,000
Idaho
Healthcare job losses: 1,200
Total jobs lost: 2,500
Colorado
Healthcare job losses: 1,200
Total jobs lost: 2,600
West Virginia
Healthcare job losses: 1,200
Total jobs lost: 2,600
Pennsylvania
Healthcare job losses: 1,000
Total jobs lost: 2,200
Oregon
Healthcare job losses: 1,000
Total jobs lost: 2,100
Virginia
Healthcare job losses: 1,000
Total jobs lost: 2,000
Illinois
Healthcare job losses: 900
Total jobs lost: 1,900
Minnesota
Healthcare job losses: 800
Total jobs lost: 1,800
Maryland
Healthcare job losses: 700
Total jobs lost: 1,300
Massachusetts
Healthcare job losses: 700
Total jobs lost: 1,600
Michigan
Healthcare job losses: 500
Total jobs lost: 1,000
Wyoming
Healthcare job losses: 500
Total jobs lost: 1,100
Washington
Healthcare job losses: 400
Total jobs lost: 800
Delaware
Healthcare job losses: 400
Total jobs lost: 800
Nevada
Healthcare job losses: 300
Total jobs lost: 700
South Dakota
Healthcare job losses: 300
Total jobs lost: 700
Nebraska
Healthcare job losses: 300
Total jobs lost: 600
Connecticut
Healthcare job losses: 300
Total jobs lost: 600
New Mexico
Healthcare job losses: 300
Total jobs lost: 600
Alaska
Healthcare job losses: 300
Total jobs lost: 700
New Hampshire
Healthcare job losses: 200
Total jobs lost: 400
Iowa
Healthcare job losses: 200
Total jobs lost: 500
Vermont
Healthcare job losses: 200
Total jobs lost: 400
Maine
Healthcare job losses: 100
Total jobs lost: 300
Rhode Island
Healthcare job losses: 80
Total jobs lost: 170
Hawaii
Healthcare job losses: 70
Total jobs lost: 140
Montana
Healthcare job losses: 70
Total jobs lost: 160
Wisconsin
Healthcare job losses: 70
Total jobs lost: 140
North Dakota
Healthcare job losses: 30
Total jobs lost: 70
District of Columbia
Healthcare job losses: 20
Total jobs lost: 50