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In total, due to the One Big Beautiful Bill Act and other policy changes, the number of people without health insurance is expected to increase by about 17 million. If all of this comes to pass, it would represent the biggest roll back of health insurance coverage ever due to federal policy changes.
Until Congress passes the reconciliation bill, Marketplace insurers will face uncertainty regarding the regulatory landscape and may find it difficult to set premiums for 2026.
A CMS rule, once finalized, is generally intended to exist permanently or until it is repealed.... This temporary implementation may preserve the potential for the reconciliation bill to generate official savings through changes to ACA marketplaces in later years (2027–2034) if enacted.
Our polling finds that most of Medicaid’s working population say losing their coverage would have direct consequences for their financial and personal well-being.
President Trump has vowed to impose tariffs on a wide variety of goods from multiple countries. While consumers may expect the price of some imported goods to go up, what may be surprising is that these tariffs are already driving health insurance premiums up.
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.
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.
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.
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.
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