Health Care is Local: Impact of Income and Geography on Premiums and Premium Support
The American Health Care Act (AHCA) proposes a significant change in how and to whom premium tax credits are dispersed, proposing a flat rate adjusted only by age. The Affordable Care Act (ACA) bases its premium tax credit calculation on three factors: age, income and local cost of insurance premiums. While there has been extensive discussion of the impact of eliminating premium support based on consumers’ income, there has been relatively little on what happens when credits are not adjusted based on where a consumer lives. By failing to account for local variation, a premium tax credit structure could lead to significant increases in premiums and out-of-pocket costs paid by consumers while also potentially reducing plan availability for those who live in relatively high cost and rural areas of each state.
This issue brief provides an overview of the context and potential impact of changing the health insurance premium tax credit structure from one that factors for age, income, and local premium costs to one that considers only age.
See also:
State fact sheets: Estimated AHCA and ACA Premiums and Tax Credits by State, Income, Age, and Select Counties.
Map: County-by-county Premium Variation



For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 























































































































































