KBRA releases research discussing the anticipated increase in uncompensated care across the health care ecosystem following the expiration of enhanced premium tax credits at the end of 2025—although the magnitude of the impact remains uncertain. This trend has negative credit implications for hospitals and creates knock-on pressures for states already facing budgetary constraints stemming from the One Big Beautiful Bill Act (OBBBA).

While there are proposals in Congress to address the expiration of the enhanced premium tax credits, none represent a long-term solution and enactment remains uncertain. In KBRA’s view, the risk of rising uncompensated care and mounting financial pressures at the state and local levels will remain ongoing credit concerns.

Key Takeaways

• Absent congressional action, enhanced premium tax credits will not be renewed, and current legislative proposals do not offer a long-term solution.
• Hospitals are likely to absorb the cost of increased uncompensated care, which will not be fully addressed by existing public programs designed to mitigate shortfalls.
• Policy changes in Washington are shifting greater responsibility for funding certain federal programs to state and local governments, with some states expanding subsidies to partially offset higher premiums.
• Given constrained governmental budgets and gloomy consumer sentiment, these dynamics amount to a zero-sum game and will continue to pressure the credit profiles of municipal issuers.

Click here to view the report.

Recent Publications

• One Big Beautiful Bill: Ugly Costs for State and Local Governments
• Preparedness Policy in Limbo: FEMA, Federal Funding, and the Future of Disaster Recovery

About KBRA

KBRA, one of the major credit rating agencies, is registered in the U.S., EU, and the UK. KBRA is recognized as a Qualified Rating Agency in Taiwan, and is also a Designated Rating Organization for structured finance ratings in Canada. As a full-service credit rating agency, investors can use KBRA ratings for regulatory capital purposes in multiple jurisdictions.

Doc ID: 1013223

View source version on businesswire.com: https://www.businesswire.com/news/home/20260128069826/en/