If Congress allows the enhanced Affordable Care Act (ACA) premium tax credits to expire, millions of working families will lose health care coverage while millions of others will face sharply higher premiums. With four Republicans breaking ranks to vote with Democrats and force a House vote on whether to extend the credits, Congress now has a chance to avert this crisis. Losing the tax credits would be an added blow for households already squeezed by rising costs and tight budgets. But a deeper story emerges when we look at who stands to lose the most. A forthcoming analysis from the Economic Policy Institute and Groundwork Collaborative finds that Black Americans in some of the nation’s largest metropolitan areas would face deep coverage losses and financial harm if credits expire.1

This analysis was produced in partnership with Groundwork Collaborative.

More than 170,000 Black adults in 10 major metro areas would lose health care coverage in 2026 if the ACA credits expire, with the largest losses in Atlanta, Houston, Dallas, and Miami. Losing insurance wipes away a basic source of security for working families and reverses gains made under the ACA, which disproportionately reduced uninsured rates for Black adults​​—narrowing longstanding racial coverage gaps. 

Our analysis shows that coverage loss is only the first shock. Families who lose insurance and families who remain covered both face significant new burdens, and the costs are substantial across the 10 metropolitan areas.

• Allowing the ACA credits to expire would lead to more than 200 preventable Black deaths each year. These deaths stem directly from the loss of affordable coverage and reduced access to timely care. 
• Black families would pay $740 million more in annual premium costs. Black families who are able to keep their health insurance would be squeezed by higher health care costs, further straining already tight household budgets.
• Local economies in major metros with large Black populations would lose more than $1.9 billion each year. Atlanta, Houston, and Dallas metros would lose the most economic activity as federal subsidies disappear and household spending contracts because families must redirect more of their income toward higher premiums and away from spending on local goods and services. 

Table 1

Allowing the ACA premium tax credits to expire would make it harder for U.S. families to access health care, worsen an ongoing affordability crisis, and negatively impact local economies. These shocks would be felt acutely by Black workers and their families because they reflect longstanding structural inequities that influence who has access to affordable health care. Black workers are less likely to hold jobs that provide employer-provided health insurance, more likely to live in states that did not expand Medicaid, and more likely to skip or delay medical care due to costs. Moreover, ending the tax credits would reduce economic activity and lower productivity in the cities where Black families live.

The pursuit of equity in this moment requires us to hold fast to the gains we have made thus far, both to limit the suffering of as many U.S. families as possible and to help us build toward further progress. Acting to extend the ACA premium tax credits until such a time that health costs can be significantly reduced is smart, responsible, and race-conscious economic and public health policy.

Note

1. Pre-Trump economic conditions were examined in these 10 metro areas in EPI’s “A tale of 10 cities” report, which discusses various threats imposed by the Trump administration’s historic rollback of federal, civil, and workers’ rights protections. The underlying methodology combines Census microdata, federal Marketplace enrollment data, and state-level projections of coverage loss. The forthcoming report will provide complete technical details.

Last month, U.S. Senator Bill Cassidy (R-La.) unveiled a package of four bills that he described as advancing President Trump’s purported “pro-worker” agenda. But there is nothing in the legislation to address the problems workers face when they try to organize unions at their workplace. In fact, Senator Cassidy’s bills construct new barriers to worker organizing and create new incentives for employers to undermine workers’ rights.

Below, we compare Senator Cassidy’s bills to the Protecting the Right to Organize (PRO) Act, which is comprehensive legislation to reform our nation’s broken labor law system. As you can see, it’s clear which legislation actually helps workers.

Table 1

Three key takeaways:

• More than 8.3 million workers will get a raise starting January 1 as 19 states raise their minimum wages.
• For the first time, there will be more workers in states with a $15 or greater minimum wage than in states with the federal minimum of $7.25.
• Minimum wage increases are critical for improving affordability. State and federal policymakers should ensure wage floors meet the needs of all workers.

Nineteen states will increase their minimum wages on January 1, boosting earnings for more than 8.3 million workers by a total of $5 billion. In addition, 47 cities and counties will raise their minimum wages, adding to the number of workers likely to get larger paychecks because of lawmakers—or in some cases, voters—taking action to lift state and local wage floors.

Figure A

State minimum wage increases this January will boost wages for a broad range of working people and help shape a more equitable economy. Our estimates account for all affected workers: Both those directly receiving an increased minimum wage and those indirectly affected as employers adjust their wage ladders to the new wage floor. According to our analysis:

• Women make up the majority (58.1%) of affected workers.
• Black and Hispanic workers will disproportionately benefit. 10.7% of affected workers are Black, despite being 8.7% of the workforce in these states. Meanwhile, 38.3% of affected workers are Hispanic, despite being 19.8% of the overall workforce in these states.
• The vast majority (87.4%) of affected workers are adults, not teenagers.
• A quarter (25.3%) of affected workers are parents. 4.8 million children live in households with at least one worker receiving a pay increase.
• Nearly half (49.4%) are full-time workers and 41.4% have at least some college education.
• More than one in five (21.0%) affected workers have household incomes below the poverty line and 48.8% are within 200% of the poverty line.

Boosting the minimum wage is good affordability policy

Minimum wage increases are an essential tool for putting money in workers’ pockets. As concerns about rising prices and affordability dominate the news cycle, it is critical to recognize that “affordability” is a function of both prices and wages. And while prices in most cases are unlikely to decline significantly, policymakers can make decisions that boost wages for workers. In Hawaii, the minimum wage increase from $14.00 to $16.00 an hour will raise annual wages by $1,346 for a full-time worker (see Figure A). Missouri’s increase from $13.75 to $15.00 an hour will boost annual wages by $920 for a full-time worker.

Price increases are squeezing workers today because lawmakers for decades have made policy decisions that suppress workers’ pay, including allowing the federal minimum wage to stagnate. The federal minimum wage has not increased from $7.25 an hour in more than 15 years, during which time its value has eroded by more than 30%. In 2025, the federal minimum wage is below the poverty line, but it is still the law of the land in 20 states that have more than 60.2 million total workers (see Figure B).

Policymakers can protect the value of the minimum wage over time as prices increase. Many of the states with small wage increases in January, like Minnesota, are making annual inflation adjustments to their wage floor. Not only do these adjustments automatically protect workers’ purchasing power over time, they also provide predictability to employers, allowing them to anticipate and plan modest adjustments to worker pay each year. Despite the prudence of inflation adjustments, conservative policymakers in some states have still opposed it. In Missouri, Republican lawmakers stripped a successful minimum wage ballot measure of its indexing provision, leaving low-wage workers vulnerable to a weakening wage standard over time.

In 2026, more workers will live in a state with at least a $15 minimum wage than a $7.25 minimum wage

In the past decade, dozens of states have passed significant minimum wage increases to counteract federal inaction. In 2026, minimum wages in Arizona, Colorado, Hawaii, Maine, Missouri, and Nebraska will reach or exceed $15 an hour for the first time, meaning that a total of 17 states and Washington D.C. will reach that threshold. For the first time, there will be more workers living in a state with a $15 or higher wage floor than workers living in states still stuck at $7.25 (see Figure B). These increases have taken place in urban and rural states as well as politically “blue” and “red” ones. This milestone reflects the progress of the minimum wage movement over the past decade but also underscores the gap between how workers in some states are paid relative to their peers doing the exact same jobs elsewhere in the country. There are still 14 million workers earning less than $15 an hour who have been left behind because Republican lawmakers at both the federal and state level have denied them a raise.

Figure B

More states could pass a $15 minimum wage soon, despite interference from conservative policymakers. In 2020, Virginia passed legislation to reach a $15 minimum wage by 2026, but the law required reauthorization by the state legislature by July 2024. Republican Governor Glenn Youngkin repeatedly vetoed those planned increases. Governor-elect Abigail Spanberger has promised to support a minimum wage increase. In Oklahoma, Republican Governor Kevin Stitt delayed a vote on a 2024 $15 minimum wage ballot measure until June 2026.

These delays not only push back potential wage gains for workers, they also chip away at the value of those increases because of inflation. Because the Oklahoma policy is a ballot measure, the language cannot be adjusted to account for the lost time since 2024. However, policymakers in Virginia could enact a new minimum wage target that accounts for the higher-than-expected inflation since the pandemic. This would likely mean a minimum wage of $16.64 in 2026 or $17.02 in 2027.1

Rising prices mean higher minimum wage targets are necessary throughout the country

Rising costs of living throughout the country will require policymakers to target minimum wages at higher levels than have been typical in recent years. When striking fast food workers in New York City sparked the Fight for $15 movement in 2012, the buying power of a $15 minimum wage was substantially higher than it is today. In 2025, a $15 minimum wage does not achieve economic security for working people in most of the country. This is particularly true in the highest cost-of-living cities. Table 1 compares the 2026 minimum wage and living wage for select metro areas across the country. The living wage standards are from EPI’s Family Budget Calculator (FBC), a measure of a modest yet adequate standard of living for families in each U.S. metro area and county. The living wage standards are for a single adult, assuming 81% of their total income is from wages.

The minimum wage does not exceed the FBC’s living wage in any county, but minimum wage increases make a significant difference for workers. Oklahoma City has the lowest living costs listed in the table, but the state minimum wage of $7.25 is only 42% of the living wage ($17.31). By comparison, Seattle will have a $21.30 minimum wage in 2026, almost 80% of the living wage in the metro despite its higher cost of living. Even outside of especially high-cost localities, strong minimum wage policies have set wage floors much closer to the living wage needs for workers. For instance, Missouri’s $15 minimum wage is 81% of the living wage in Kansas City, Mo. ($18.51).

Table 1

Workers are continuing to demand higher wages so that they can afford to live in the communities where they work. Hospitality workers in Los Angeles are poised to gain a $30 minimum wage, although the city council could water down the increases. The New York City mayoral campaign and new efforts in D.C. are also elevating ambitious minimum wage policies. As shown in Table 4, dozens of localities in Arizona, California, Colorado, and Washington are already implementing minimum wage targets above $17, $18, and $19 an hour. Seven localities in Washington will have minimum wages above $20 an hour.

Research has consistently shown that increasing the minimum wage remains a powerful tool for making the economy more equitable without causing job losses. The affordability crisis underlines how essential it is for federal, state, and local policymakers to take action so that workers are not left further behind, but lawmakers have taken relatively little new action on minimum wage policy in recent years. Of the 19 state increases this January, only two (Rhode Island and Michigan) are the result of policies passed in 2025. In addition, while Colorado, D.C., and Michigan all boosted their minimum wage this year, they also reinforced carve-outs for tipped workers. Even as millions of workers get raises this January, state and federal policymakers must do more to ensure their wage floors meet the needs of all workers.

Table 2 Table 3 Table 4 Note

1. According to CBO CPI-U projections in January 2020, $15.00 in 2026 was equivalent to $13.00 in 2020. If we adjust $13.00 an hour to account for actual CPI-U increases and CBO projections for future growth (September 2025 projections), the equivalent value is $16.64 in 2026 or $17.02 in 2027. 

Below, EPI senior economist Elise Gould offers her insights on the jobs report released this morning, which showed 41,000 jobs lost over October and November. Read the full thread here. 

Today the BLS releases two months of payroll data and one month of household data. A little jarring to see the first gap in data on the unemployment rate in the history of the survey. Second thing to note is that the unemployment rate is now 4.6% a significant rise from 4.0% in January.
#NumbersDay

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— Elise Gould (@elisegould.bsky.social) Dec 16, 2025 at 7:36 AM

On the payroll side, there were net job losses in three of the last six months. Job growth averaged only 17,000 over the last six months, a significant slowdown.
#EconSky #NumbersDay

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— Elise Gould (@elisegould.bsky.social) Dec 16, 2025 at 7:50 AM

Downward revisions for August and September plus large losses in October—due to an enormous drop in federal workers at the end of September—has meant a significant slowing in the pace of job growth. The three-month moving average of job growth fell from 232k in January to 62k in November.
#EconSky

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— Elise Gould (@elisegould.bsky.social) Dec 16, 2025 at 8:03 AM

Attacks on the federal workforce reached a fever pitch in October as federal employment fell by a whopping 162,000. Federal employment has shrunk an alarming 271,000 since January. The shutdown furloughs have no impact on these data. The cost of these losses are only beginning to be felt.
#EconSky

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— Elise Gould (@elisegould.bsky.social) Dec 16, 2025 at 8:16 AM

Health care employment continued to rise, adding 46,000 jobs in November. Construction added jobs as well, but manufacturing and transportation and warehousing sectors continues to lose jobs, 58k losses in manufacturing and 60k losses in transportation and warehousing since January.
#NumbersDay

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— Elise Gould (@elisegould.bsky.social) Dec 16, 2025 at 8:29 AM

While federal cuts drove large losses in October, it’s important to note that private-sector employment grew an average of only 44k per month over the last six months, down from an average growth rate of 130k in 2024. Employment is undeniably slowing this year and it’s not just about federal cuts.

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— Elise Gould (@elisegould.bsky.social) Dec 16, 2025 at 8:46 AM