His Thursday letter came in response to an inquiry from U.S. Sens. Jeanne Shaheen (D-N.H.) and Ron Wyden (D-Ore.) along with Reps. Richard Neal (D-Mass.) and Lauren Underwood (D-Ill.) about "the effects on health insurance coverage and premiums that will result from not extending—either for one year or permanently—the expanded premium tax credit structure."
"Without an extension through 2026, CBO estimates, the number of people without insurance will rise by 2.2 million in that year," Swagel said. "Without a permanent extension, CBO estimates, the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026-2034 period."
"Without an extension through 2026, CBO estimates, gross benchmark premiums will increase by 4.3%, on average, for that year," the director continued. "Without a permanent extension, CBO estimates, gross benchmark premiums will increase by 4.3% in 2026, by 7.7% in 2027, and by 7.9%, on average, over the 2026-2034 period."
"If Congress fails to act, healthcare will become out of reach for millions of Americans, leaving middle-class families to struggle and choose between seeing a doctor or keeping a roof over their heads or groceries in the fridge."
The analysis comes as the world braces for GOP control of Congress and the White House, with President-elect Donald Trump set to be sworn in next month. Since President Barack Obama signed the ACA—also known as Obamacare—in 2010, elected Republicans including Trump have repeatedly
tried to gut or fully repeal the law.
In response to the CBO report, Wyden said, "This is a stark preview of healthcare under Donald Trump: higher insurance premiums for families who buy health coverage on their own, and more uninsured Americans who can't afford health insurance at all."
"Republicans have an opportunity to end their ideological crusade against the Affordable Care Act and work in a bipartisan manner to make healthcare more affordable for working families, but instead they seem poised to hand another big tax break to corporations and the wealthy," warned Wyden, the outgoing Senate Finance Committee chair.
In September, Shaheen and Underwood introduced a bill to make the ACA's enhanced premium tax credits permanent. Shaheen
said Thursday that the "new data from CBO confirms what we feared: if Congress fails to extend these tax credits, healthcare costs will skyrocket for millions of families and 3.8 million Americans will lose coverage entirely."
"At a time when Americans are already facing higher prices, we should do everything we can to lower costs when and where we can," she added. "It's time we pass my Health Care Affordability Act to permanently extend the tax credits so many families rely on."
Advocacy groups echoed demands for Congress to at least extend the subsidies following the CBO's findings.
"If Congress fails to act, healthcare will become out of reach for millions of Americans, leaving middle-class families to struggle and choose between seeing a doctor or keeping a roof over their heads or groceries in the fridge,"
said Protect Our Care executive director Brad Woodhouse in a statement.
"Instead of helping hardworking families, Republicans have opposed measures to lower healthcare costs and have instead focused on delivering tax breaks to big corporations and the wealthiest Americans," he continued. "Health coverage gives people peace of mind knowing they won't go bankrupt over an injury or illness. Democrats stand ready to extend the tax credits to ensure everyone has access to affordable healthcare. It's time for Republicans to get on board."
While the CBO found with the expiration of the credits, "on average, those with health insurance will see their unsubsidized gross monthly premiums increase by as much as 8% each year," Anthony Wright, executive director of Families USA,
pointed out that "for people who now receive premium assistance, the increases will be far steeper."
"Taking into account the cuts in premium assistance, nonpartisan organizations,
such as the Center on Budget and Policy Priorities, report that people will experience estimated premium increases ranging from 41% to 218%, with a median increase of 91%—a near doubling of their monthly costs," he explained.
"For nearly 20 million Americans, these enhanced tax credits have been the difference between getting access to the healthcare and coverage they need or going without it," Wright stressed. "At a time when so many families are struggling to pay for the basics, these tax credits have been a literal lifeline for millions of people to get healthcare they can afford."
"Voters just made it clear in the 2024 election that they want action to lower costs—and so it would be cruel to have the result be inaction that allows these tax credits to expire, and monthly healthcare costs to jump," he added. "For many millions of working Americans, premiums will double. For some, the spike will be not just hundreds but thousands of dollars of additional costs, leading many millions to lose coverage altogether. Congress must protect the health and financial security of our nation's families right now by extending these critical tax credits."
Citing several unnamed sources, The Washington Post reported Friday afternoon that Democrats on Capitol Hill privately proposed a deal to extend the ACA subsidies by a year, which "accompanied a broader package of healthcare proposals submitted to Republicans on Thursday night ahead of year-end spending negotiations."
"It is not yet clear whether Republican leaders, who control the House, will agree to any of the proposals," the Post noted. "Spokespeople for Republicans on the House Ways and Means and the Senate Finance committees declined to comment."
Despite efforts to salvage the ACA subsidies due to the pain and economic suffering that would follow if they are not extended, progressives across the board continue to argue that Obamacare—which sends billions of federal dollars to the private insurance industry—is a far inferior solution compared with Medicare for All, which would cover everyone in the United States at a lower overall cost than the current system.
(Chart: Institute on Taxation and Economic Policy) 
(Chart: Institute on Taxation and Economic Policy) 