The Health Coverage Tax Credit (HCTC) pays 65 percent of health insurance premiums for about 16,000 trade-displaced workers, early retirees receiving payments from the Pension Benefit Guaranty Corporation, and their families. It is the country's only use of refundable federal income tax credits to cover the otherwise uninsured. Its success or failure matters, not just to the households depending on the program for health coverage, but also to broader national trade and health policy. Offering tax credits to the uninsured is often cited as one way to provide more Americans with health coverage. The concept is popular with many lawmakers; several Republican and Democratic presidential candidates have proposed such tax credits. Yet, HCTC faces significant challenges, including limited participation due to affordability, liquidity, complex enrollment and limited coverage and high administrative costs. Just 15 percent of eligible workers and their families participate. In this Urban Institute policy brief, health policy expert Stan Dorn analyzes how these tax credits can be restructured to reach more workers who qualify and how future tax credits could be designed to serve millions of uninsured Americans more effectively. Congress is considering changes to HCTC as part of Trade Adjustment Assistance reauthorization. This brief describes these congressional proposals and suggests additional approaches both to address HCTC's problems and to prevent similar difficulties with future tax credits aimed at a larger group of uninsured Americans.