A coalition of 14 Democratic governors penned a letter to the leaders of the House and Senate on Tuesday asking for Congress to take action to permanently expand the availability of advanced premium tax credits. 

The federal health care subsidy has, since the launch of the Affordable Care Act, been a way for individuals enrolled in a health care marketplace insurance program to lower their monthly premium payments. When applying for coverage, individuals must estimate their income for that year; should they qualify, plan holders can get an advance tax credit to use for healthcare premium payments. 

Last year’s American Rescue Plan expanded the availability of those tax credits, in part, by setting an 8.5% cap on how much of their yearly income families can spend on health premiums and allowing families making 400% more than the federal poverty level eligible for the credits for the first time. 

But the expansions were temporary, and are set to expire at the end of this calendar year. 

The coalition of governors who signed on to Tuesday’s letter, which was first published by Punchbowl, encouraged the House and Senate to make the expansions permanent, writing: “At a time when governments at all levels are struggling to find ways to reduce costs for the American people, we cannot allow the looming specter of rising health costs to cause more uncertainty and stress for American families.” 

The co-signatories of the letter spanned across the country, including New York’s Gov. Kathy Hochul, North Carolina’s Gov. Roy Cooper and California’s Gov. Gavin Newsom. The group noted that the expansion of the tax credits led 14.5 million Americans to sign up for marketplace coverage last year, which included approximately 3 million new consumers at a 21% increase from the year before. 

“Unfortunately, the ARP-expanded subsidy eligibility is set to expire at the end of the current plan year, leaving consumers exposed to dramatic premium increases, and threatening the progress we have made,” the governors wrote in part. “As inflation continues to put a strain on consumers’ budgets, we are concerned that many people will choose to reduce health insurance coverage or even go without coverage if Congress fails to act.

“Healthcare is a right—not a privilege,” the letter continued. The ARP greatly improved health insurance affordability to ensure lifesaving healthcare is accessible to all Americans. We urge you to take action immediately to make the ARP expanded subsidies permanent to prevent a disastrous erosion of health insurance coverage.” 

The group of governors are not the only ones calling on Congress to take action on the advance premium tax credit expansion.

In May, six national health organizations – the American Academy of Family Physicians, the American Hospital Association, the American Medical Association, AHIP, Blue Cross Blue Shield Association and the Federation of American Hospitals – called on Congress to “act now to make these expanded tax credits permanent, ensuring millions of low- and middle-income families continue to have access to affordable coverage in 2023 and beyond.” 

The organizations posited that should the expansion cease at the end of this year, enrollees with the lowest incomes could see their monthly premiums increase by 2,500% from $1 to $26. The Biden administration also estimates that around 3.4 million consumers, roughly the amount of new enrollees last year, would lose healthcare coverage altogether should Congress not make the advance premium tax credits permanent. 

It’s unclear if there are enough votes in Congress to make the expansion permanent, but Republicans are unlikely to agree to spend more money on the Affordable Care Act. Sen. Joe Manchin of West Virginia, a moderate Democrat who has, in the past, posed a challenge to his party’s goals, suggested earlier this month he would support an expansion targeted at lower-income families. 

"The main thing here is the means-testing," he told Business Insider. "We should be helping the people who really need it the most and are really having the hardest time. [...] With healthcare, people need help. They really do.”