Health insurance costs are rising as financial assistance declines. Here’s how C-U could be affected – IPM Newsroom

Report on Affordable Care Act Subsidies and Sustainable Development Goals

Executive Summary

The impending expiration of enhanced tax subsidies for the Affordable Care Act (ACA) marketplace poses a significant threat to progress on several United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 1 (No Poverty), and SDG 10 (Reduced Inequalities). A failure to extend these subsidies is projected to double average insurance premiums, leading to millions losing health coverage and exacerbating socio-economic disparities. This report analyzes the potential impacts based on current projections and policy debates.

Impact on SDG 3: Good Health and Well-being

The primary impact of the subsidy expiration directly contravenes the objectives of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The potential consequences represent a significant setback for achieving universal health coverage in the United States.

• Loss of Health Coverage: The Congressional Budget Office estimates that four million people will become uninsured if the subsidies expire. This loss of access to essential health services is a direct challenge to SDG Target 3.8 (Achieve universal health coverage).
• Strain on Health Systems: The Champaign County Health Care Consumers (CCHCC) reports that an increase in uninsured individuals will lead to a rise in uncompensated care. This places a severe financial burden on healthcare providers, particularly in rural areas, potentially compromising the stability and quality of local health systems.
• Market Instability: Uncertainty surrounding the subsidies is contributing to rising premium costs, as insurers adjust to a volatile market. This instability undermines the creation of a resilient and accessible healthcare financing system.

Implications for SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities)

The financial ramifications of increased healthcare costs are directly linked to poverty and inequality, making this a critical issue for SDG 1 and SDG 10.

1. Increased Financial Hardship (SDG 1): The doubling of insurance premiums would force many families to choose between health coverage and other basic needs, increasing the risk of financial hardship and poverty. The subsidies are a key mechanism for protecting households from catastrophic healthcare expenditures.
2. Exacerbated Inequalities (SDG 10): The loss of affordable coverage would disproportionately affect lower-income individuals and families, widening the gap in healthcare access and health outcomes between different socio-economic groups. Misinformation regarding the eligibility of undocumented immigrants for subsidies further complicates the policy debate, though CCHCC clarifies that these individuals have never been eligible, framing the issue as one of sound health policy for all eligible residents.

Institutional Framework and Policy Context (SDG 16)

The situation highlights challenges related to SDG 16 (Peace, Justice and Strong Institutions), as legislative and institutional actions are central to the outcome.

• Governmental Impasse: The political debate over extending the ACA subsidies has become a central point of contention in federal budget negotiations, leading to a government shutdown and demonstrating a challenge to effective governance and institutional function.
• State-Level Initiatives: In a positive institutional development, Illinois has launched its own state-run health insurance marketplace for the first time. This move represents an effort to create a more localized and potentially more stable system for residents, in line with the principles of effective and accountable institutions at all levels.
• Enrollment Period: Open enrollment for 2026 ACA plans is scheduled from November 1, 2025, to January 15, 2026. While enhanced premium tax subsidies are at risk, regular premium tax subsidies remain available to eligible consumers.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses issues related to health insurance affordability, access to healthcare, and social protection systems, which directly connect to several Sustainable Development Goals (SDGs). The primary SDGs addressed are:

• SDG 3: Good Health and Well-being

  This is the most prominent SDG in the article. The entire discussion revolves around the Affordable Care Act (ACA), health insurance premiums, and the risk of millions of people becoming uninsured. The article’s focus on ensuring people have health coverage to access healthcare services is central to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

• SDG 1: No Poverty

  The article connects healthcare costs to financial stability. The potential for premiums to “more than double” without subsidies could lead to significant financial hardship for families. High healthcare costs are a major driver of poverty. The subsidies discussed are a social protection measure designed to prevent individuals and families from falling into poverty due to unaffordable health insurance.

• SDG 10: Reduced Inequalities

  The article touches upon inequality by highlighting the particular difficulties that uncompensated care can create “especially in rural areas,” suggesting a geographic disparity in the healthcare system’s resilience. Furthermore, the ACA subsidies are income-based, designed to reduce inequality in access to healthcare by making it more affordable for lower-income individuals. The discussion about disinformation regarding undocumented immigrants also touches on social inclusion and equitable access to social benefits.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets can be identified:

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…

  The article is fundamentally about this target. The ACA marketplace and its subsidies are mechanisms designed to move towards universal health coverage. The warning that “four million people will lose their coverage” and become uninsured if subsidies expire is a direct threat to this target. The discussion of rising premiums and the need for “financial assistance resources” relates directly to providing financial risk protection.

• Target 1.3: Implement nationally appropriate social protection systems and measures for all… and achieve substantial coverage of the poor and the vulnerable.

  The ACA premium tax subsidies are a clear example of a “nationally appropriate social protection system.” The article explains that these subsidies are “tied to people’s income” to help them afford health insurance. The potential loss of these subsidies represents a weakening of this social protection system, directly impacting its coverage of vulnerable populations.

• Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.

  The debate over extending the ACA subsidies is a debate about a specific fiscal and social protection policy. These subsidies are a policy tool designed to reduce the financial burden of healthcare on lower-income individuals, thereby promoting greater equality in health access. The article highlights the political struggle to maintain this policy.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions or implies several indicators that can be used to measure progress:

• Indicator for Target 3.8 (Universal Health Coverage):

  • Number of insured vs. uninsured people: The article explicitly states that the Congressional Budget Office estimates “four million people will lose their coverage… and become uninsured” if subsidies expire. This number serves as a direct indicator of the population covered by health services.
  • Affordability of health insurance premiums: The article mentions that “average monthly premiums for 2026 plans are expected to more than double on average” without subsidies. The ratio of premium costs to income is an implied indicator of financial risk protection and healthcare affordability.

• Indicator for Target 1.3 (Social Protection Systems):

  • Population covered by social protection programs: The “four million people” who stand to lose coverage are a direct measure of the population covered by this specific social protection program (the ACA subsidies). The number of people enrolled in the marketplace using subsidies is a key performance indicator for this target.

• Indicator for Target 10.4 (Policies for Equality):

  • Existence and funding of social protection policies: The central conflict of the article—the political debate over extending the ACA subsidies—is itself an indicator. The continuation or expiration of this policy is a measure of the government’s commitment to using fiscal policy to achieve greater equality in healthcare access. The article notes that “enhanced premium tax subsidies were not extended through the budget bill,” which is a direct indicator of a policy change.

4. Table of SDGs, Targets, and Indicators

Source: ipmnewsroom.org