House passes extension of Marketplace enhanced premium tax credits (ePTCs)

On Jan. 8, 2026, 17 Republicans joined Democrats in the House to pass a clean three-year extension of the Marketplace enhanced premium tax credits (ePTCs) that expired on January 1st. The extension passed with a 230-196 vote, restoring access to these subsidies for three years without any changes.

Before their lapse, in rural areas, ePTCs saved rural enrollees an average of $890 per year, which is about 28% more than their urban counterparts. Rural residents also benefit the most from ePTCs, with benchmark premiums in rural areas being about 10% higher than in urban areas. If ePTCs are not restored, rural residents with Marketplace coverage will feel the greatest impact: rural areas are projected to see a 30% drop in Marketplace coverage and a 37% rise in the number of people without insurance. The domino effect of decreased health coverage in these areas would further exacerbate rural population health outcomes. 

NRHA is pleased to see productive, bipartisan movement towards an extension of these critical tax credits in the House. NRHA urges the Senate to work towards a bipartisan solution to ePTCs and support affordable health care coverage for their rural constituents.

For more information on state-level coverage data, please find NRHA’s state fact sheets here. You can find maps for district and state-level data and impacts from Keep Americans Covered here.

NRHA encourages you to emphasize the importance of ePTCs for rural residents to your Senators by using our ePTCs advocacy campaign.