January 13, 2026

The Affordable Care Act premium tax benefits are back in the news as the U.S. House of Representatives has voted for a three-year extension of these benefits, which would otherwise expire January 30th. Now the Senate must vote. This measure could affect the physical and mental health care of literally millions of rural Americans. Mental health diagnoses and treatment are common among ACA Marketplace enrollees.  Without insurance, rural residents – who often face clinic closures and provider shortages – will find it especially difficult to seek treatment.

Largely lost among the concerns about the ACA’s enhanced premium tax credits are the disproportionate impact they will have on rural America. If they are not extended, the effect on rural America would likely be severe and disproportionate, both for physical AND mental health. 

How severe?  Nationally, allowing these credits to expire is expected to result in 4 million more uninsured individuals and dramatically lower ACA Marketplace participation – possibly by as much as 50% in rural states. This is particularly important in mental health care, which depends heavily on coverage, particularly Marketplace plans, which offer protections and essential benefits needed for access.

Why does all this matter? Negative impacts on rural communities can reverberate across the country. You may not realize it, but regardless of where you live – a city, the suburbs, in the country – you depend upon the mental and physical wellness of the rural population. Through agriculture, ranching, aquaculture, and forestry, they grow or raise, process, and package the food that fills your grocery store shopping cart.

Please join Rural Minds in making our voices heard. Congress needs to act on this by January 30, 2026! The House of Representatives has passed this measure; contact your U.S. Senators to urge them to make this a priority to take action to prevent these needed health benefits from lapsing. You can read more about this issue here.