Women's Coverage Losses in 2023 If the American Rescue Plan Act's Premium Tax Credits Expire

A nurse practitioner examines a patient.

Without access to comprehensive health coverage, hundreds of thousands of women of reproductive age will likely lose access to contraception and reproductive health services.


The Issue

Millions of women are already at risk, and 850,000 more, will lose comprehensive health insurance coverage if American Rescue Plan Act’s (ARPA) premium tax credits expire.

Key Findings

  • Of the additional women at risk of becoming uninsured if the tax credits are not extended, nearly 600,000 live in one of the 12 states that have not expanded Medicaid eligibility. Researchers project uninsurance rates for adult women of reproductive age will be nearly twice as high in non-expansion states (19.3%) than in expansion states (10.2%).

  • Around 2.5 million uninsured women of reproductive age currently live in states rated as “most” or “very” restrictive by the Guttmacher Institute in allowing access to abortion.

  • If premium tax credits are extended, 384,000 fewer women of reproductive age in “most” or “very” restrictive abortion states would be uninsured and would maintain no-cost access to effective forms of contraception.

  • Women able to maintain enrollment in Marketplace coverage in 2023 would have free access to contraception and other reproductive health services, and comprehensive benefits to support a healthy pregnancy, delivery, and ongoing maternal health.


Researchers determine if the premium tax credits expire, many women will lose comprehensive health insurance coverage that creates access to contraception, cancer screenings, and reproductive health services. Failure to extend these credits will be consequential, especially for women in states that tightly restrict access to abortion.

About the Author/Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.