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Taken together, the reconciliation bill's provisions impose additional administrative burdens on state-based marketplaces and could limit state flexibility in choosing marketplace policies and procedures.
Republicans are not talking about repealing and replacing the ACA anymore, and the budget reconciliation bill doesn't do that, at least not directly. However, the bill would restrict health insurance for many people who have been helped by the ACA, and it would be the biggest rollback in federal support for health coverage ever.
ACA Marketplace changes are technical and numerous but consequential. While more attention has been focused on cuts to Medicaid, upcoming changes to the ACA Marketplaces could lead to just as many people losing health insurance coverage.
Insurers in 12 states that require abortion coverage would not be able to access federal funding for reduced cost-sharing under the House provision. How this would get resolved, and what would happen to abortion coverage for low-income ACA enrollees in these states, is unclear.
A revision made to the bill before it was considered by the Rules committee expanded the penalty from 14 states and DC that cover undocumented immigrants with state funds to 33 states and DC that use a federal option available in Medicaid and/or CHIP to expand coverage for lawfully residing children and/or pregnant people.
Taken together, the new guidance on clinical trial requirements, the more restricted approval of the Novavax vaccine, and anticipated changes to CDC recommendations add up to fewer Americans eligible for COVID-19 vaccines and more limited access to these vaccines compared to previous years...such a shift would place the U.S. more in line with Australia, Canada, and countries in Europe.
If enacted into law in its current form, and Congress takes no further action, [the House reconciliation bill's] increase in the deficit would trigger mandatory cuts, also known as sequestration, under the Statutory Pay-As-You-Go Act of 2010.
Recent federal proposals may affect Medicaid coverage and treatment access at a time when opioid deaths are declining but future trends are uncertain.
KFF data show that as of April 2025, 14 states plus DC use state-only dollars to provide health coverage to children regardless of immigration status, including 7 states that also do so for at least some adults.
Ultimately, assessing the impact of President Trump’s newest iteration of “Most Favored Nation” drug pricing depends on details that have yet to be fleshed out.
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