Leveraging the Enhanced Premium Tax Credit

Ensuring Delaware small business employees and self-employed workers have access to healthcare coverage

BY WILLIAM WILSON

THE AFFORDABLE CARE ACT’S (ACA) Marketplace health insurance products and Medicaid expansion has meaningfully impacted the health of people across communities nationwide, bringing coverage to 6.2 million small business employees and self-employed workers in the U.S. (1)

In 2013, almost one-third of the 36.3 million Americans employed by businesses with fewer than 50 employees were uninsured. (2) By 2022, that number fell to less than 17%. (3) Over the same period, the uninsured rate for self-employed workers fell from 27.3% to 16.4%. (4) Meanwhile, across the state of Delaware, the total population of uninsured people was cut nearly in half, from 10% to 5.5% (5)

A large part of this significant improvement in coverage can be attributed to actions Congress undertook in the American Rescue Plan to enhance the ACA’s premium tax credits (PTCs), making marketplace products more affordable for consumers. As a result of the enhanced PTCs, a record-breaking 21.4 million people selected a marketplace health insurance plan in 2024, a 30% increase over the previous year. (6) These enhanced PTCs are set to expire at the end of next year, and it’s important that Congress works to extend these at their earliest convenience to ensure Americans—and Delawareans—continue to have the security and peace of mind that comes with health insurance coverage.

Delaware alone saw more than 44,000 new enrollees in 2024, a nearly 30% increase compared to the prior year. (7) Under Insurance Commissioner Trinidad Navarro’s leadership, Delaware has a competitive and stable marketplace that allows consumers to choose from more than 50 products offered by four marketplace insurance companies, including our company—Ambetter Health of Delaware. With PTCs, Delawareans at all income levels have experienced lower premiums, and many low-income consumers have had access to zero-cost plans. If the enhanced PTCs were to expire next year, some Delawareans could see their premiums increase hundreds of dollars per month. (8)

Thanks to the efforts of Congress, the Delaware’s Insurance Commissioner, Trinidad Navarro, the General Assembly, and Governor John Carney, our state’s Marketplace is stronger than ever for the thousands of Delawarean small business employees and self-employed workers that rely on it for quality health coverage. We must all commit to continue working together to ensure our strong marketplace continues, ensuring a healthier tomorrow for more Delawareans.

1. Center on Budget and Policy Priorities, ACA Drove Record Coverage Gains for Small-Business and Self-Employed Workers, (Jul. 2024), https:// www.cbpp.org/blog/aca-drove-record-coverage-gains-for-small-business-and-selfemployed-workers.

2. Kaiser Family Foundation, The Uninsured: A Primer – Key Facts About Health Insurance and The Uninsured In America, p. 11 (Dec. 2014), http://files.kff.org/attachment/the-uninsured-a-primer-key-facts-abouthealthinsurance-and-the-uninsured-in-america-supplemental-tables.

3. CBPP, at footnote 1.

4. Id.

5. Kaiser Family Foundation, State Health Facts – Health Insurance Coverage of the Total Population, https://www.kff.org/other/state-indicator/ total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22L ocation%22,%22sort%22:%22asc%22%7D.

6. Center on Budget and Policy Priorities, Record Numbers of People Chose ACA Marketplace Coverage for 2024.

7. Kaiser Family Foundation, State Health Facts – Marketplace Enrollment, 2014 – 2024, https://www.kff.org/affordable-care-act/stateindicator/marketplace-enrollment/?currentTimeframe=10&sortModel=%7B%2 2colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

8. Center on Budget and Priorities, Health Insurance Costs Will Rise Steeply if Premium Tax Credit Improvements Expire, (Jun. 2024), https://www.cbpp. org/research/health/health-insurance-costs-will-rise-steeply-if-premium-taxcredit-improvements-expire.

William Wilson is plan president and CEO of Delaware First Health. Delaware First Health (DFH) is a Centene company, a leading healthcare enterprise that is committed helping people live healthier lives. In 2023, DFH became one of Delaware’s three Medicaid Managed Care Organizations. Additionally, DFH’s leadership team provides local leadership for Centene’s Delaware Marketplace product, Ambetter Health of Delaware, and their Medicare product, Wellcare.