Iowa Health Care Compromise 2026

Inside Iowa Politics: Looking for compromise on health care costs

Estimated reading time: 5 minutes

Key takeaways

• End of enhanced premium tax credits: Enhanced premium tax credits have ended for Americans who purchased health insurance through the ACA, lifting some premiums for many up to 400% of the federal poverty level. So, now what?
• Congressional action stalled: Republicans in Congress chose to allow the tax credits to expire at year’s end. They have yet to approve legislation through both chambers that would reduce health care costs for Americans.
• Policy options on the horizon: The 2026 landscape could include re-establishing the enhanced credits for one, two, or three years, or deciding not to reinstate them at all.
• Alternate ideas: Some Republicans, including President Donald Trump, have suggested that Americans could receive federal assistance via a health savings account instead, which could be cheaper for taxpayers but would likely place more of the cost on individuals.

Table of Contents

Background on ACA premium credits

Enhanced premium tax credits under the ACA, which helped millions of Americans with premiums for people up to 400% of the federal poverty line, have ended. The previous taxpayer support meant significantly cheaper premiums for millions. The article notes that enhanced premium tax credits have ended, and the future remains uncertain. The Democratic-led Affordable Care Act subsidies helped many gain access to coverage, but they did not lessen the cost of health care overall.

Current political landscape

Republicans in Congress chose to allow the tax credits to expire at year’s end and have yet to approve legislation through both chambers that would reduce health care costs for Americans. The content emphasizes that the ACA subsidies helped many gain access to coverage, but they did not lessen total health care costs. Some Republicans, including President Donald Trump, have suggested that Americans could receive federal assistance via a health savings account instead. That approach could be cheaper for taxpayers but would likely shift more of the premium cost onto individuals.

Potential policy pathways for 2026

Congress may consider a variety of options in 2026 like re-establishing the enhanced premium tax credits for one, two, or three years. Or it could decide not to bring back those credits. Some Republicans including Trump have suggested HSAs as an alternative. Each pathway carries trade-offs between government spending, taxpayer costs, and coverage access.

What readers can do and how it affects you

How is the higher cost of health care affecting you in 2026? Email Dave Price at dave.price@graymedia.com.

For more context, readers can follow ongoing coverage of Iowa politics and health care cost discussions as policy options evolve in 2026.