Overview
- The shutdown stems from a dispute over federal health care funding, particularly the extension of Enhanced Premium Tax Credits (ePTCs) for Affordable Care Act marketplace plans, which expire at the end of the year and would raise premiums nationwide
- In Maine, 54,000 people (85% of CoverME.gov users) rely on ePTCs, with rural residents benefiting most. Allowing ePTCs to expire would increase premiums — especially for older adults in rural areas — by an average of 77% and could prompt some to drop coverage
- Expiring ePTCs would reduce federal funding by $42 million, cost 500 jobs, lower state and local tax revenue by $6 million, and decrease overall spending in Maine’s economy, particularly in rural communities
The standoff that has led to the shutdown of the federal government since October 1 is centered on a fight over health care. Democrats in Congress want continuation of federal funding to include a roll back of some of the Medicaid cuts in the Republicans’ reconciliation bill that was passed this summer — and the extension of enhanced subsidies for individuals buying insurance through the Affordable Care Act’s individual marketplace (known as CoverME in Maine). Because the enhanced subsidies expire at the end of this year and will impact people shopping for health care beginning November 1, this aspect of the health care fight has received most attention.
Without an extension of the Enhanced Premium Tax Credits (ePTCs) first introduced in 2021, millions of people nationwide will face substantially higher premiums for their health insurance in January. What’s more, even for people who don’t receive ACA-subsidized health insurance, the failure to renew the premiums has already caused insurers to hike rates across the board.
In Maine, 54,000 people are currently using ePTCs to reduce their premiums, or 85% of all people using the CoverME.gov online platform. Mainers in rural counties are most likely to enroll in coverage through CoverME.gov, because more people are likely to be self-employed in these areas or working in jobs that do not offer health insurance. Analysis of the impact of ePTCs also shows Mainers in rural areas receive greater benefits from the enhanced tax credits compared to the regular tax credits — both because the cost of health care plans is higher in rural areas and because families in those areas tend to be older.
The ePTCs provide extra support to the existing premium tax credits (PTCs) under the Affordable Care Act. PTCs pay the difference between the second lowest-priced “silver” tier plan offered on the exchange and a share of an individual’s annual gross income. The level at which the premium is capped depends on the ratio of an individual’s household income to the federal poverty level (FPL). Importantly, the Trump administration is not only allowing the ePTCs to expire but is also changing the regular PTC schedule so customers will be responsible for a larger share of their premiums than in 2020, before the ePTCs were introduced.
Here is a comparison of the premium caps under the ePTCs and the new schedule for 2026:
| Federal poverty level | Enhanced cap | New income cap for 2026 |
|---|---|---|
| Under 133% | No subsidy — Mainers at this income level qualify for expanded MaineCare | |
| 133-150% | 0% | 3.14-4.19% |
| 150-200% | 0-2% | 4.19-6.60% |
| 200-250% | 2-4% | 6.60-8.44% |
| 250-300% | 4-6% | 8.44-9.96% |
| 300-400% | 6-8.5% | 9.96% |
| Over 400% | 8.5% | No subsidy — Mainers at this income level pay full price |
Note: Even the lowest-income Mainers do not qualify for completely free health insurance through the exchange, because Maine law requires insurers include some services for abortion care that are not covered by ACA subsidies. As a result, the lowest price plans are around $1 per month.
According to Maine’s Department of Health and Human Services, if ePTCs are allowed to expire, the average premium for CoverME.gov members will increase by 77%, but the amount will vary greatly by income, age, family situation, and geography. Some groups will be particularly hard hit:
- Older adults living in rural areas, who face some of the highest sticker prices for premiums
- Households with incomes over 400% of the federal poverty level, whose subsidies disappear entirely
- Households with incomes between 133% and 150% of the federal poverty level, who previously had nearly all their premiums covered by enhanced subsidies, will now have to pay around 3% of their annual income toward premiums
The following examples show just how much some Mainers could end up paying:
| Scenario | Annual income | Annual premium with ePTC | Annual premium without ePTC | Increase |
|---|---|---|---|---|
| 50-year-old couple with kids age 20, 15 and 12, Lisbon | $120,000 | $7,760 | $11,950 | 54% |
| 60-year-old couple with child age 25, Calais | $107,000 | $9,177 | $47,300 | 415% |
| Couple age 40 and 38 with kids 8 and 5, Kittery | $100,000 | $6,280 | $9,960 | 59% |
| 60-year-old couple, Fort Kent | $85,000 | $7,200 | $38,490 | 435% |
| Couple age 30 and 27 with a 1 year-old, Fairfield | $82,000 | $4,920 | $7,550 | 53% |
| 63-year-old couple, Bangor | $50,000 | $1,730 | $3,370 | 95% |
| 40-year-old individual, Portland | $35,000 | $1,167 | $2,556 | 119% |
| 30-year-old parent with 2-year-old, Lewiston | $30,000 | $13 | $1,118 | 8,500% |
MECEP adaptation of examples presented by Maine Department of Health and Human Services and data from CoverME.gov. Prices are for the benchmark second-lowest cost “silver tier” plan.
Mainers can preview their own health insurance costs for 2026 using CoverME.gov, or see how much of a difference the extension of ePTCs could make using this tool from KFF.
A failure to extend ePTCs inflicts a double whammy on Mainers. Not only does it end the extra subsidies to afford insurance premiums, but the sticker price for those premiums increases — including for people who don’t receive ACA subsidies. Insurance companies expect the end of ePTCs will lead some people to drop coverage altogether, particularly folks who are relatively healthy and more likely to risk going uninsured. This means the remaining consumers in the marketplace will be less healthy and carry risks for insurers. According to Maine DHHS, if ePTCs were extended, the sticker price for premiums in the individual market would be 9% lower. In other words, allowing ePTCs to expire increases costs for all of us.
The end of ePTCs would also ripple through the economy. Either Mainers will have to find more money to cover insurance premiums themselves, or they will drop their insurance coverage and spend less on health care services. Both scenarios mean less money flowing in Maine’s economy, particularly in rural parts of the state, where more people use ePTCs and where hospitals are significant local employers. According to a report from the Commonwealth Fund, the end of ePTCs would result in $42 million in lost federal funding for Maine, the loss of 500 jobs, and $6 million less per year in state and local tax revenue.
With financial hardship looming for tens of thousands of Mainers, and bigger implications for the rest of us, Congress must end the shutdown and extend ePTCs. Allowing them to expire would put health care out of reach for many and weaken Maine’s economy.