Krishnamoorthi, Preckwinkle, Cook County Leaders Warn ACA Tax Credit Expiration Will Double Premiums, Strain Cook County Health and Stroger Hospital

Congressman Raja Krishnamoorthi (D-IL) joined Cook County Board President Toni Preckwinkle, Dr. Lauren Smith, Chief Medical Officer, Donnica Austin-Cathey, Chief Hospital Executive-Stroger, and other Cook County leaders today at John H. Stroger, Jr. Hospital of Cook County to warn that the expiration of enhanced Affordable Care Act (ACA) premium tax credits at midnight will sharply raise health care costs and place severe strain on Cook County Health and its flagship safety-net hospital.

"Letting these ACA tax credits expire isn't an accident-it's a choice," said Congressman Krishnamoorthi. "Republican leadership must allow a vote to extend these credits and stop blocking action to protect Medicaid from devastating cuts. Without action, premiums will nearly double, families will lose coverage overnight, and Cook County Health and Illinois taxpayers will be forced to absorb the fallout."

"At Cook County Health, we will help patients navigate coverage changes, and provide the care they need, but we can not do it alone. Our efforts will not be able to offset the loss of federal support. Letting the Affordable Care Act subsidies expire will cost people in our community their insurance, their health, and in some cases, their lives. We urge policymakers to consider the consequences of allowing these subsidies to expire," said Donnica Austin-Cathey, Chief Hospital Executive, Stroger Hospital, Cook County Health.

More than 550,000 Illinois residents are enrolled in the ACA marketplace in 2025, including over 360,000 Cook County residents, roughly 90 percent of whom rely on premium tax credits to afford coverage. If the credits expire, average monthly ACA premiums in Cook County are projected to rise by about 95 percent, pricing many families out of insurance overnight.

Health care leaders warned that coverage losses will hit safety-net hospitals first. In 2023, charity and discounted care at John H. Stroger, Jr. Hospital totaled nearly $140 million, almost six times more than the next closest hospital in Illinois. Increased uncompensated care is expected to place additional financial pressure on Cook County Health and local taxpayers.

The ACA coverage cliff comes as Cook County Health faces additional strain from President Trump's "One Big Beautiful Bill Act," which cut Medicaid by more than $1 trillion nationwide and imposed new work requirements. More than 3 million Illinois residents-one in four statewide-depend on Medicaid, which accounts for approximately 56 percent of Cook County Health's patient revenue. The system estimates it could lose $88 million annually in Medicaid reimbursements as patients lose coverage.

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