An overview of the proposed ACA-related changes
Before we dive into it, here's a quick glance at the provisions included in the bill that passed the House. I've also updated to include the provisions from the Senate bill but they're not included in this snapshot list.
- Revised standards for income verification processes
- Modified eligibility redetermination procedure
- Denial of coverage for Deferred Action for Childhood Arrivals (DACA) recipients accomplished by removing them from the definition of “lawfully present” for eligibility and enrollment in Marketplace and Basic Health Program (BHP) coverage
- New requirement for pre-enrollment verification for Special Enrollment Periods (SEPs)
- Adoption of the evidentiary standard CMS uses to assess whether to terminate an agent’s, broker’s, or web-broker’s Marketplace Agreements for cause
- Prohibit issuers from providing coverage of sex-trait modifications as an essential health benefit (EHB)
- Revise actuarial value standards for health plans
- Require Marketplaces to deny eligibility for advance payments of the premium tax credit (APTC) upon a tax filer’s failure to reconcile APTC for one year
- Revise the automatic re-enrollment hierarchy
- Change the annual Open Enrollment Period (OEP)
- Eliminate the SEP for persons with annual household incomes below 150% of the federal poverty level (FPL)
- Revise the premium adjustment percentage methodology
- stabilize the risk pool,
- lower premiums, and
- reduce improper enrollments with a goal of
- improving health care affordability
- improving health care access while
- maintaining fiscal responsibility.
A quick read of the details makes it obvious to anyone capable of critical thinking that this simply isn't true and the actual goal is to increase barriers to care for certain groups/populations of consumers in the US. This is especially disappointing since one of the original three goals of the ACA is to ELIMINATE BARRIERS TO AFFORDABLE HEALTH CARE.
QUICK FACTS FROM KFF
I have positioned this up front so we get a feel for what’s at stake here before we even start talking about anything else:
"Congressional Republicans are considering a budget reconciliation package that would make significant changes to Medicaid and the Affordable Care Act (ACA). For example, the Energy and Commerce Committee released legislative text that includes work and reporting requirements for certain Medicaid enrollees and codifying changes in a recent Trump Administration proposed rule on the ACA Marketplaces, among other policy changes.
The Congressional Budget Office (CBO) estimates that, taken together, these changes will result in at least 13.7 million more uninsured people in the year 2034 than would otherwise be the case, including:
- 1.8 million more uninsured from codifying the recent Trump Administration proposed rule on the ACA Marketplaces
- 7.7 million more uninsured resulting from a combination of Medicaid and other ACA changes (that go beyond the proposed rule)
- 4.2 million more uninsured with expiration of the enhanced premium tax credits, relative to an estimate of a permanent extension of those credits"
A quote from the Association of State and Territorial Health Officials (ASTHO):
On May 22, the House of Representatives passed the One Big Beautiful Bill Act (H.R. 1) by a 215-214 vote. This reconciliation bill proposes changes to Medicaid, the Affordable Care Act, food nutrition programs, and the nation’s debt limit, among other things.
If this bill were signed into law, several potential impacts to states include:
- Increased coverage loss for noncompliance with work requirements.
- Future challenges for states to fund their share of Medicaid and SNAP.
- Limitations on how states incentivize high-quality care or improve access to care as a result of caps on future state-directed payments.
- Potential increase in food insecurity for vulnerable populations.
And one more thing to keep in mind going forward…
The Original Three Goals of the ACA
Expand health insurance access
The ACA aimed to ensure that more people had access to affordable health insurance by creating a system (the marketplaces) where individuals AND small businesses could purchase SUBSIDIZED insurance plans.
Expand Medicaid coverage
The ACA expanded Medicaid eligibility to include more low-income individuals, particularly those with incomes up to 138% of the FPL (federal poverty level).
Reduce healthcare costs
The ACA sought to lower healthcare costs through various mechanisms, including supporting innovative healthcare delivery models and promoting competitions between insurers.
As you read these proposed changes, ask yourself how they are going to help achieve any of these goals. (Spoiler alert: THEY WON'T and I feel like many of them aim to do the exact opposite.) Also remember that I've only included the ACA-RELATED PROVISIONS here. There are also major changes proposed for Medicaid, Medicare, and Health Savings Accounts (HSAs) so stay tuned. I'm going to do my best to do a similar summary for those (while also trying to finish publishing my Marketplace comprehensive guide I've been working on since last year. By the time I get it all published, I'll have to go back and rewrite it because of all these changes but hey - doing this helps me learn and I like sharing the knowledge because some of this stuff is so unbelievable I'm just glad to have a witness!)
Okay okay okay. Before my ADHD brain totally derails this train of thought, for better or worse, let's dig into it. I love KFF but when I turned to them for a summary of these provisions, I could not read it the way it was presented so I put it in a format I could understand. I hope it works for you, too. Just in case it doesn't, the link to the source doc from KFF is included below, along with links for further information (as always).
There are currently some sections with no links at all and this is due to a huge lack of reliable info as things are continuing to change and develop so rapidly. I will add relevant links as I'm able to find them if they're a solid source and I can feel confident in standing behind the facts they're reporting. Also, my patience with typing with arthritis is wearing thin as I get older. I've used abbreviations and acronyms in this quite a bit more than I usually like to because I don't want readers who don't know them to feel left out. If you don't know one of them, just click this text for the CMS Acronyms reference. There are 4,421 acronyms/abbreviations included so I'm confident it will cover whatever you're looking for AND it's searchable!
WAIT! WE HAVE AN UPDATE!
UPDATE AS OF JUNE 17, 2025
(via Tracking the Affordable Care Act Provisions in the 2025 Reconciliation Bill | KFF)
First came the Big Ugly Bill (I refuse to say the actual name) and the House passed their Budget Reconciliation Bill on May 22. There's now a Senate-proposed bill with a whole new set of proposals as of June 16. I'm going back and adding those details at literally the last minute. I got up this morning to proof my blog post one last time before publishing it and just became aware of this development a couple of hours ago.
After the new info is added, I'm publishing without looking back so if there are formatting mistakes or something doesn't get linked or anything like that, bear with me. I'm not actually a news reporter. I just apparently play one on the internet.
The Senate bill does not propose changes to all of the same sections as the House Budget Reconciliation Bill so I'm only adding them where they apply. If there's a section that says nothing about the Senate proposal for that issue, it's because they didn't address it.
For ease of formatting and to (hopefully) keep from wrecking my previous work, the Senate bill details have been added under the content boxes for the current law and the House bill. Thank you for your patience. Share some with me, please, because my patience level is getting LOW. Effective dates for the Senate portions are in the content box with them. The effective dates next to the links underneath the content boxes are the proposed dates for the provisions from the House bill. I apologize for the confusion.
UPDATE AS OF JUNE 24, 2025
Right after I finished adding and formatting the content from the Senate bill, the HubSpot editor glitched and I lost half of my previous work and ALL of the updated content. I decided in a moment of frustration to scrap the whole thing but haven't been able to let it go so I'm redoing it and publishing now, as-is. I hope it helps someone understand what we're up against. As I said before, if there any formatting or linking errors or anything, bear with me. I can barely see straight at this point due to having grown so incredibly tired of this piece and the topic itself. Please contact me and I'll be glad to fix anything I missed.
DETAILS OF CURRENT LAW VS ACA–RELATED PROVISIONS FROM BILL
(Source: Tracking the Affordable Care Act Provisions in the 2025 Reconciliation Bill | KFF)
Open Enrollment Period (OEP)
EFFECTIVE DATE: Plan years beginning Jan 1, 2026 (OEP beginning Nov 1, 2025)
- Affordable Care Act Archives | KFF
- Open Enrollment Period - Glossary | HealthCare.gov
- When can you get health insurance? | HealthCare.gov
Special Enrollment Periods (SEPs) (E&C)
Current Law
- In addition to QLEs (qualifying life events) that enable eligibility for a SEP, people who live in states that use Federally-Facilitated Marketplaces (FFM) and make no more than 150% of the FPL (federal poverty level) can apply for a YEAR ROUND SEP to sign up for coverage.
- Some state-based marketplaces (SBMs) also offer SEPs that are based on the relationship of people's income to the poverty line.
- In 2025, about half (46%) of enrollees had an income of LESS THAN 150% OF THE FPL.
House Budget Reconciliation Bill
- Eliminates the year-round enrollment opportunity for people with incomes up to 150% of poverty (low-income SEP).
- Limits the ability of all Marketplaces (including SBMs) to provide specific types of SEPs that are based on the relationship of people's income to the poverty line.
- Requires enrollees prove eligibility to enroll before enrolling.
Senate-Proposed Bill
No provision, but see section below about ending financial assistance for people who do enroll via a non-QLE SEP.
EFFECTIVE DATE: plan years on or after Jan 1, 2026
- Affordable Care Act Archives | KFF
- Get or change coverage outside of Open Enrollment | HealthCare.gov
- Special Enrollment Periods (SEPs) & Qualifying Life Events (QLEs) (from Jensurance!)
Special Enrollment Periods (SEPs) and tax credit eligibility (W&M)
Current Law
- In addition to QLEs that enable eligibility for SEPs, people who live in FFM states and make no more than 150% of the FPL can apply for a year-round SEP to sign up for coverage.
- Some state-based exchanges also offer SEPs based on the relationship of people's income to the FPL.
- Any person who enrolls in a plan via an SEP is eligible for BOTH premium tax credits (PTCs) and cost-sharing reductions (CSRs).
- In 2025, people with an income of less than 150% FPL made up the LARGEST SHARE of all Marketplace enrollees (47%)
House Budget Reconciliation Bill
- Ends low-income SEPs
- Bars any consumer who enrolls in a plan via a non-QLE SEP from receiving either PTCs or CSRs
Senate-Proposed Bill
Same as the Ways & Means portion of the House bill, but with a different date of effectiveness.
EFFECTIVE DATE: plan years beginning after Dec 31, 2025
| Author's note: I can't see how this can be viewed as anything other than a deliberate barrier to low income individuals' access to affordable care, putting it in direct opposition to the original goals of the ACA. |
EFFECTIVE DATE: The third full calendar month following the date the bill is enacted
- Explaining Health Care Reform: Questions About Health Insurance Subsidies | KFF
- Special Enrollment Periods (SEPs) & Qualifying Life Events (QLEs) (from Jensurance!)
Verifying personal information (E&C)
Current Law
- Enrollees only have to attest their information to enroll in a Marketplace plan, but there is electronic verification against Internal Revenue Service (IRS), Social Security Administration (SSA), Department of Homeland Security (DHS), and state Medicaid databases.
- Enrollees are granted conditional eligibility if there's a mismatch in their info provided and the databases.
- Enrollees can retain COVERAGE & TAX CREDITS UP TO 90 DAYS while submitting verification documents.
House Budget Reconciliation Bill
- In cases where household (HH) income or family size data are not available with the Treasury Department, enrollees will need to provide additional documentation and "CAN NO LONGER SIMPLY SELF ATTEST TO CHANGES OF HH INCOME AND FAMILY SIZE."
- Creates new triggers for FULL INCOME VERIFICATION BY THE EXCHANGE when all of the following are true: 1) an individual attests to being subsidy eligible, 2) government and third-party data suggests their income is lower than would be needed to qualify for a subsidy, 3) the individual is not eligible for Medicaid
- Removes the automatic 90 day extension of coverage while HH income verification docs are submitted and reviewed.
Senate-Proposed Bill
No provision, but see section below about pre-enrollment verification.
EFFECTIVE DATE: plan years on or after Jan 1, 2026
Verifying personal information (W&M): Pre-enrollment verification of eligibility for premium tax credit (PTC)
Current Law
- ↑ All from above ↑ plus:
- Enrollees who take no action during OEP are AUTO-RENEWED into the same or similar plan.
- Nearly HALF of Marketplace enrollees in 2025 auto-renewed.
House Budget Reconciliation Bill
- Requires that ⬧ income, ⬧ immigration status,⬧ health coverage status, ⬧ place of residence, ⬧ family size, and ⬧ any other info that the Secretary and Health and Human Services (HHS) deems necessary are VERIFIED BEFORE COVERAGE.
- Consumers can still enroll in a plan, but CAN'T RECEIVE PTCs or CSRs (subsidies) UNTIL AFTER VERIFYING ELIGIBILITY.
- This provision effectively ENDS AUTO-RENEWALS.
Senate-Proposed Bill
Requires pre-enrollment verification of eligibility, but with some notable differences from the House bill:
• Exchanges do not have to additionally verify consumer eligibility for CSRs before a consumer can qualify for PTCs.• Specifies exchanges must use applicant’s “household income” for verification. House bill only references “income.
• Specifies exchanges must verify whether applicant is an “eligible alien.” House bill requires verification of “any immigration status.”
• Exchanges can use any third-party sources and any available data for verification.
• Verification requirements may be waived for individuals enrolling during SEPs due to changes in family size.
EFFECTIVE DATE: Taxable years beginning after Dec 31, 2027
EFFECTIVE DATE: taxable years beginning after Dec 31, 2027
- Death by Slow Strangulation: New Tactics in Longstanding Efforts to Repeal the Affordable Care Act | CHIRblog
- The Annual Renewal Process on HealthCare.gov - Beyond the Basics
Filing and reconciling
Current Law
- Enrollees who receive any amount of premium tax credits must file and reconcile their premium tax credits every two years.
- Failure to do so will lead to ineligibility for premium tax credits.
- In 2025, about 92% of Marketplace enrollees or over 22 million people received premium tax credits.
House Budget Reconciliation Bill
- Enrollees who have received any amount of premium tax credit must file and reconcile their premium tax credits on an annual basis.
- Failure to do so will lead to ineligibility for premium tax credits.
Senate-Proposed Bill
No provision, but see section below on repayment of the premium tax credit.
EFFECTIVE DATE: plan years on or after Jan 1, 2026
- Affordable Care Act Archives | KFF
- FAQs: Health Insurance Marketplace and the ACA | KFF
- Health Insurance Marketplace Calculator | KFF
Actuarial value (AV)
| AUTHOR'S NOTE: I have to admit that I barely understand this one, if I understand it at all. If it doesn't make sense to you, you are not alone! Here's a quick definition to help us understand enough to get through reading it. |
Actuarial value:
The percentage of total average costs for covered benefits that a plan will cover.
For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy. Actuarial value - Glossary | HealthCare.gov
Current Law
- The allowable variation of AV of a health plan is +/- 2 percentage points to be considered a certain metal level (except for silver plans, which have a 0/+2 de minimis range).
- For example, a bronze plan is a health plan with an AV of 60%, so any plan with an AV ranging between 58% and 62% is also considered a bronze plan.
- In 2024, the average medical deductible in plans with combined medical and prescription drug deductibles was $7,258 for bronze plans and $5,241 for silver plans.
- Increasing the lower range of allowable actuarial value variation decreases deductibles and cost-sharing at each metal level.
House Budget Reconciliation Bill
- Reverts allowable variation in actuarial value back to variation allowed in plan year 2022, which ranges between -4 percentage points and +2 percentage points.
- For example, a bronze plan is a health plan with an AV of 60%, so any plan with an AV ranging between 56% and 62% is also considered a bronze plan.
- The de minimis variation in actuarial value for silver plans is now +/- 1 percentage point.
EFFECTIVE DATE: plan years beginning on or after Jan 1, 2026
- What the Actuarial Values in the Affordable Care Act Mean
- Deductibles in ACA Marketplace Plans, 2014-2025 | KFF
- Affordable Care Act Archives | KFF
- Actuarial value - Glossary | HealthCare.gov
Premium adjustment percentage (PAP) methodology
Current Law
- The PAP is the percentage that the average employer-sponsored insurance (ESI) per capita premium for the previous calendar year exceeds the average per capita premium.
- The PAP is used to index the maximum annual limitation on cost sharing, employer mandate penalties, and income thresholds for some affordability exemptions.
- In 2025, the maximum annual limitation on cost sharing was $9,200 for individuals and $18,400 for families
House Budget Reconciliation Bill
- Reverts the PAP methodology to that of 2019.
- The 2019 methodology uses individual market premiums to index these measures, which causes the PAP to grow more slowly and pass more cost-sharing onto the consumer over time.
EFFECTIVE DATE: calendar years beginning Jan 1, 2026
Recapture of excess premium tax credits
Current Law
- Currently, if an enrollee receives excess premium tax credits because their estimated income was lower than their actual income, they must repay the excess. However, for most enrollees, there is a repayment cap that varies based on household income.
- For enrollees with household incomes over 400% of the federal poverty level (FPL), there is no limit. They must repay the entirety of their excess tax credit.
- Other repayment limits vary from $375 for a single person with an income that is less than 200% FPL to $3,150 for families with an income between 300%-400% FPL.
House Budget Reconciliation Bill
- Requires that all premium tax credit recipients repay the full amount of any excess, no matter their income.
Senate-Proposed Bill
Same as the House bill with one exception:
Includes a safeguard for individuals who project they will make at least 100% FPL but actually have incomes less than 100% FPL. If individuals did not act “with intentional or reckless disregard for facts” when attesting their income, they will not have to repay their excess tax credits.
EFFECTIVE DATE: taxable years beginning after Dec 31, 2025
EFFECTIVE DATE: taxable years beginning after Dec 31, 2025
| AUTHOR'S NOTE: This one is a big deal. ↑ This is what people worry so much about and what I worried about when I got my APTC the first time. My agent reassured me by telling me about the cap on how much or little would need to be paid back or I don't think I could have accepted it the first time because of worry. |
Premium underpayments and effectuation of coverage
Current Law
- Consumers can still have their coverage effectuated if at least 95% of their first premium payment is paid.
- Additionally, in a given month, insurers consider enrollees to have paid their full premium if they've paid at least 98% of their premium or have an unpaid remainder of $10 or less.
- Further, insurers cannot deny coverage even if an individual has failed to pay premiums associated with an old policy.
House Budget Reconciliation Bill
- Permits insurers to require enrollees pay the full amount of their first month’s premium to have their coverage effectuated.
- Permits insurers to require the full premium to be paid in a given month to retain coverage.
- Permits insurers to require payment for the first month's premium, as well as any unpaid, past-due premiums before effectuating coverage.
EFFECTIVE DATE: plan years beginning on or after Jan 1, 2026
- Explaining Health Care Reform: Questions About Health Insurance Subsidies | KFF
- Premium Payments and Grace Periods - Beyond the Basics
- Past-Due Premiums in the Marketplace
Automatic reenrollment
Current Law
- Insurers are not typically allowed to automatically reenroll consumers in different plans than what they initially are enrolled in.
- However, an insurer is allowed to enroll a consumer who initially was enrolled in a bronze plan in a silver plan if they qualify for cost sharing reductions (CSRs) (have an income between 100%-250% of the federal poverty line) and could be missing out on significant cost sharing help.
- In 2025, 45% of all Marketplace enrollees or over 10 million people were automatically reenrolled in their plan or a similar plan from the previous year
House Budget Reconciliation Bill
- Discontinues the practice of automatically reenrolling individuals eligible for CSRs who were in a bronze level plan into a silver plan to receive CSRs.
- Requires enrollees with a zero-dollar premium (after tax credits) who are automatically reenrolled in Marketplace coverage to proactively verify their ongoing eligibility for fully subsidized plan or face a $5 monthly charge (reduction in their tax credits) until they actively confirm their eligibility.
- Note: A different provision (pre-enrollment verification, described above) effectively ends auto-reenrollment altogether (regardless of metal level)
Senate-Proposed Bill
No provision similar to the E&C portion of the House bill, but see section above about pre-enrollment verification, which effectively ends auto-renewals altogether.
EFFECTIVE DATE: plan years beginning on or after Jan 1, 2026
CHOICE arrangements
Current Law
- The Individual Coverage Health Reimbursement Arrangement (ICHRA) was created in 2019 via rulemaking by the first Trump Administration.
- ICHRA allows employers to reimburse employees, on a pre-tax basis, for all or a portion of their health insurance premiums in the individual market.
- However, employees with an ICHRA can only use pre-tax dollars via a Section 125 cafeteria plan to pay for off Exchange individual market plans, not for on Exchange (ACA Marketplace) plans.
House Budget Reconciliation Bill
- Codifies much of the 2019 Trump Administration rule that created ICHRAs.
- Allows employees with an ICHRA to use pre-tax dollars through a cafeteria plan to pay for on Exchange ACA Marketplace premiums.
EFFECTIVE DATE: taxable years beginning after Dec 31, 2025
Employer credit for CHOICE arrangements
Current Law
- The Individual Coverage Health Reimbursement Arrangement (ICHRA) was created in 2019 via rulemaking by the first Trump Administration.
- ICHRA allows employers to reimburse employees, on a pre-tax basis, for all or a portion of their health insurance premiums in the individual market.
- However, employees with an ICHRA can only use pre-tax dollars via a Section 125 cafeteria plan to pay for off Exchange individual market plans, not for on Exchange (ACA Marketplace) plans.
House Budget Reconciliation Bill
- Codifies much of the 2019 Trump Administration rule that created ICHRAs.
- Allows employees with an ICHRA to use pre-tax dollars through a cafeteria plan to pay for on Exchange ACA Marketplace premiums.
EFFECTIVE DATE: taxable years beginning after Dec 31, 2025
Prohibits coverage of gender affirming care as an EHB (essential health benefit)
Current Law
- The ACA does not exclude or require gender affirming care as an essential health benefit.
House Budget Reconciliation Bill
- Amends the ACA to prohibit “coverage of gender transition procedures,” including puberty blockers, hormone treatment, and surgery, as an essential health benefit (EHB) beginning on or after January 1, 2027.
- Despite headline referencing marketplaces, could apply to other plans subject to EHB requirements (e.g. non-grandfathered individual and small group plans off the marketplaces and Alternative Benefit Plans (impacting Medicaid expansion adults).
EFFECTIVE DATE: On or after Jan 1, 2027
- How the House-Passed Budget Reconciliation Bill Would Negatively Impact Children
- Reconciliation Bill Bans Gender-Affirming Care Through Medicaid for Youth and Adults | Allies for Children
- CEC Blasts GOP Bill to Cut Medicaid & Target Trans Americans’ Healthcare | Congressional Equality Caucus
ACA Marketplace coverage eligibility for lawfully present immigrants
Current Law
- Under current law, U.S. citizens and lawfully present immigrants are eligible to enroll in ACA Marketplace coverage and receive premium subsidies and cost sharing reductions.
- Lawfully present immigrants with incomes under 100% of the federal poverty level (FPL) who do not qualify for Medicaid coverage due to their immigration status also are eligible for ACA Marketplace coverage.
House Budget Reconciliation Bill
- Limits eligibility for subsidized ACA Marketplace coverage to lawfully present immigrants who are lawful permanent residents (LPRs or “green card” holders), Compact of Free Association (COFA) migrants residing in the U.S., or certain immigrants from Cuba, eliminating eligibility for many lawfully present immigrants including refugees, asylees, and people with Temporary Protected Status beginning January 1, 2027.
- Eliminates Marketplace eligibility for all lawfully present immigrants with incomes under 100% of the FPL.
Senate-Proposed Bill
Same as the Ways & Means portion of the House bill, with one exception:
Does not limit eligibility for cost sharing reductions (CSRs) to specific classes of "eligible aliens".
EFFECTIVE DATE: beginning Jan 1, 2026
ACA Marketplace coverage eligibility for Deferred Action for Childhood Arrivals (DACA) recipients
Current Law
- Following new regulations published by the Biden administration in May 2024 making DACA recipients be considered “lawfully present” for the purposes of health coverage, DACA recipients in 31 states plus DC are currently eligible
- To enroll in Marketplace coverage and
- Receive premium subsidies and
- Receive cost sharing reductions
House Budget Reconciliation Bill
- Updates legislation to make DACA recipients in all states ineligible to purchase ACA Marketplace coverage by excluding them from the definition of “lawfully present.”
EFFECTIVE DATE: Jan 1, 2026
- Potential Impacts of 2025 Budget Reconciliation on Health Coverage for Immigrant Families | KFF
- Overview and Implications of the ACA Marketplace Expansion to DACA Recipients | KFF
Cost-sharing reductions (CSRs)
Current Law
- The ACA requires insurers to provide CSRs to people enrolled in silver plans with incomes between 100 and 250 percent of the poverty level.
- At the end of 2017, the first Trump administration announced it would stop reimbursing insurers for CSRs.
- In response, insurers raised premiums for silver plans, which determine premium tax credit amounts.
- This practice, known as “silver-loading,” allowed insurers to recover the cost of CSRs through higher premium payments while enrollees avoided higher costs by receiving larger premium tax credits.
House Budget Reconciliation Bill
- Return to funding CSRs through payments from the federal government with explicit congressional appropriation of funds.
- This provision could effectively end “silver-loading” which would reduce premiums for silver plans and subsequently reduce the size of premium tax credits.
Senate-Proposed Bill
Same as the House bill.
EFFECTIVE DATE: plan years beginning on or after Jan 1, 2026
- FAQs: Health Insurance Marketplace and the ACA | KFF
- Explaining Health Care Reform: Questions About Health Insurance Subsidies | KFF
- The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments | KFF
Limitation on use of CSR funds for abortions
Current Law
- Abortion coverage is prohibited from being required as part of the federally established essential benefit package.
- Private insurance carriers may offer a plan in the state Marketplace that includes coverage of abortion beyond those permitted by federal laws as long as they comply with the requirement to segregate federal funds.
- The ACA has no effect on state laws regarding coverage, funding or procedural requirements on abortions.
House Budget Reconciliation Bill
- Prohibits use of the appropriated CSR funds for health plans that cover abortion services except when abortion is necessary to save the life of the mother, or if the pregnancy is a result of an act of rape or incest.
Senate-Proposed Bill
Same as the House bill.
EFFECTIVE DATE: plan years beginning on or after Jan 1, 2026
- Key Facts on Abortion in the United States | KFF
- Interactive: How State Policies Shape Access to Abortion Coverage | KFF
- Coverage for Abortion Services in Medicaid, Marketplace Plans and Private Plans | KFF
THE END… 
of section 1
So that's it for the changes to the ACA. What didn't make sense? Let me know so I can clear it up for you and for everyone else (because if one person is confused by something, you can bet they're not the only one).
Now all that's left are the sections for changes to Medicare, Medicaid, and HSAs (Health Savings Accounts)! Oh boy. I can't wait.
I hate that I can't get these done faster but I'm going out of my way to be as thorough and accurate as possible so I don't post something incorrect and send someone into a panic. My one woman researching, writing, webpage building department is working as fast as it can.
After finishing this, finding out the morning I was going to publish that there was a new Senate bill, adding and formatting all that information while struggling with the HubSpot website builder, and then LOSING ALL OF THAT EXTRA WORK, I decided to quit this piece entirely out of sheer exhaustion of the subject BUT... I can't let things go that easily. I had to redo the last few sections of this altogether and am adding the Senate provisions back in the best I can without driving myself crazy. I just have to get it out of my brain and onto the blog and then I can move on to the next one. Please forgive any errors as I can't even see anymore. Please contact me and let me know of anything that needs fixing and I'll be glad to do it!
- To keep up-to-date on news and information regarding the ACA & the Marketplace, you can check out my blog!
- Go take a look at my Resources page for helpful links from the entire website, my upcoming e-book, and social media series PLUS a glossary of key terms and gallery of infographics!
- Return to the Jensurance home page
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