Main Street Alliance Helps Drive House Passage of ACA Premium Tax Credit Extension, Presses Senate to Act

Small business owners elevate healthcare affordability as an economic priority.

Washington, D.C. — Last week, the U.S. House of Representatives passed legislation extending Affordable Care Act (ACA) premium tax credits for three years, following sustained pressure from small business owners across the country. The vote marked a major step forward for healthcare affordability—but the process is not complete. The Senate has yet to vote, and Main Street Alliance is actively engaging senators to ensure the extension becomes law.

For small business owners, healthcare costs remain one of the biggest barriers to hiring, growth, and long-term stability. In the lead-up to the House vote, Main Street Alliance worked to bring that reality to the forefront by elevating the voices of employers who rely on ACA coverage for themselves, their workers, and their families.

“This House vote showed what happens when policymakers listen to Main Street,” said Richard Trent, Executive Director of Main Street Alliance. “Small business owners made clear that healthcare isn’t a partisan issue—it’s economic infrastructure. Now we’re taking that message directly to the Senate.”

Ahead of the vote, Main Street Alliance coordinated a national pressure campaign that reframed ACA premium tax credits as a small business and workforce issue. Through its Main Street Media Desk, the organization placed small business voices in national and local outlets, generating dozens of earned media hits, including coverage in USA Today, The Washington Post, and Spectrum News. One story featuring Main Street Alliance members was amplified by President Barack Obama, reaching millions and underscoring the real-world stakes of the debate.

At the same time, Main Street Alliance mobilized its 1,000 Main Streets civic engagement network, activating hundreds of business owners across more than 40 states. Members delivered a letter to House leadership representing 30,000 small business owners nationwide, highlighting a critical fact often missing from healthcare debates: more than half of ACA enrollees either run or work for small businesses.

The organization also paired education with targeted accountability, engaging lawmakers in key districts to underscore the economic and political consequences of inaction. That effort helped move three of four targeted Republican members to support the House discharge petition.

The stakes remain high. Forty-three percent of small business owners report difficulty hiring due to healthcare costs. Nearly half say they would cut back on investments if the premium tax credits expire. And 86 percent believe lawmakers do not understand the healthcare realities facing small businesses.

With Senate action still pending, Main Street Alliance is continuing to meet with elected officials, generate earned media, and mobilize small business owners to push for final passage.

“This is Main Street Alliance’s core strength,” Trent added. “We turn lived economic pressure into narrative power and real policy movement—and we’re not done yet.”

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