Patient Affordability & Health Care Access — ACP 2026 Advocacy Priority

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Make health care more affordable and accessible by lowering patient cost sharing for primary care and preventive health care services and reestablishing the enhanced premium tax credits that expired on December 31, 2025.

Why Patient Affordability & Health Care Access Matters

Patient access to affordable healthcare can be improved by making healthcare more affordable for the patient. Healthcare affordability can be enhanced through legislative, regulatory and administrative efforts to lower co-pays and deductibles for primary and preventive care services. The Centers for Medicare and Medicaid Services (CMS) is implementing a new program for Advanced Primary Care Management (APCM) services aimed at relieving administrative burdens and more appropriately reimbursing physicians caring for patients with complex medical and social needs. ACP is concerned that cost-sharing associated with these services could hinder beneficiary consent and uptake. In addition, the integrity of the United States Preventative Task Force (USPTF) must be preserved so that its decision making and recommendations are based on sound, empirical based science and data to protect public health and safety.

Enhanced premium tax credits have lowered the cost of health insurance purchased through the individual marketplace. In 2025, 93 percent of all individuals enrolled in marketplace plans (22.4 million people) received tax credits that lowered their premiums and kept coverage affordable. The enhanced premium tax credits dramatically lowered health insurance costs for our patients by an average of 44 percent, or $705 per enrollee.

While these credits expired at the end of 2025, there have been calls by legislators for Congress to reconsider and extend them, to ensure comprehensive coverage is affordable. Although we won’t know until later in 2026 how the lack of enhanced premium tax credits have affected marketplace enrollment, it’s estimated that 4.8 million Americans could lose health insurance coverage this year if Congress does not address the enhanced credits, raising the uninsured population in the U.S. by 21 percent, according to an analysis from the Urban Institute.

ACP’s Policy Position on Health Care Affordability

ACP supports efforts to make healthcare more affordable, particularly regarding evidence-based preventive services, including protecting the integrity of scientific and evidence-based recommendations made by the USPTF. Additional efforts may take the form of protecting coverage of preventive services without cost-sharing and lowering out-of-pocket costs and co-pays for primary care visits. We urge Congress to approve legislation to waive cost sharing associated with these services. APCM services, introduced to simplify and support comprehensive, team-based primary care, have traditionally carried cost-sharing obligations for beneficiaries under Medicare Part B. ACP supports CMS’ consideration of that stance in recognition that even minimal cost sharing may limit the uptake of APCM services.

ACP also supports the enhanced premium tax credits that recently expired to facilitate the purchase of health insurance in the individual market by consumers; these credits should be made permanent to reduce the cost of care for our patients.