Emergency provisions of the American Rescue Plan Act (ARPA) will expire at the end of 2022, which, if not renewed, will have adverse effects on the US health care system. ARPA increased the generosity of subsidies (premium tax credits) and reduced premiums for those purchasing individual market insurance, which largely includes households that do not receive employersponsored insurance and are not eligible for Medicaid. For households with incomes between 100% and 150% of the federal poverty

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... el (FPL; $13 590 for an individual and $27 750 for a family of 4 in 2022 1 ) or that are receiving unemployment insurance, ARPA provides a zero-premium plan that covers 94% of expected medical care costs. ARPA also eliminated the Affordable Care Act subsidy phaseout ("cliff") at 400% FPL and capped out-of-pocket premiums at 8.5% of income for all enrollees. Immediately before the pandemic, national marketplace enrollment after the 2020 open enrollment period was an estimated 11.4 million people. After the ARPA increases in subsidy generosity and large pandemic-induced losses of employer-sponsored insurance, enrollment increased to an estimated 12.0 million people in 2021 and 14.5 million people in 2022. 2