Speaking for someone who works with clients enrolling in individual market plans primarily on the Marketplace, the proposed changes are significant.
The most impactful Marketplace specific changes in our opinion (quotes are pulled from the KFF summary):
End to autorenewals: An end to autorenewals will mean every enrollee will need to be actively renewed for 2026. We push active renewals far harder than most brokers, so this will be less of a hit to us than others, but I'd expect around ~12% of our clients ignored all of the outreach encouraging active renewal and autorenewed this year. Especially for enrollees in this market for multiple years who are accustomed to their plan autoenrolling, there will be a ton of confused enrollees who either lose coverage altogether or lose their premium/plan subsidies come January.
"Requires that all premium tax credit recipients repay the full amount of any excess, no matter their income." This would be a complete removal of the repayment caps regardless of income (over or under 400% FPL). This will increase the amount of premium tax credit repayment for enrollees. Many are already afraid that they will get burned when they file if they accept the subsidies as an advance. Often I would explain how the caps work and that would effectively allay those fears. The end result will be less enrollees as some either artificially inflate their income projection leading to premiums too high for them to pay and others who decide not to enroll at all out of fear or subsidy repayment.
Also, only immigrants who are LPRs or “green card” holders would be eligible to enroll (significant reduction in who is eligible) and, of those, immigrants who are not eligible for medicaid due to not being legally present for 5 years would lose subsidy eligibility. We probably have 20-30 people in this group.
Of course, the loss of the covid-era/american rescue plan expanded premium subsidies is the biggest impact though that's not being caused by this bill specifically as they were designed to sunset at the end of 2025.
One positive: "Return to funding CSRs through payments from the federal government with explicit congressional appropriation of funds." This could reduce premiums in my state. It's bad for states that allowed "silver loading" which dramatically increased premium tax credits overall, but Indiana never allowed that.
Finally, most of these changes are set to kick in 1/1/26 which is outrageously soon given that carriers are filing rates for 2026 right now. If passed, HHS and the carriers will struggle to implement and provide notice of all of these changes by the start of OEP.
The current administration and Congress could find themselves in damage control mode by Christmastime or earlier. This is because of the combined financial strain from: sharply rising health insurance costs for individuals and the loss of medicaid benefits, the restarting and increasing burden of federal student loan payments throughout the fall, and market disruptions caused by tariffs and general ongoing regulatory uncertainty across all industries.
Unfortunately, there are no silver bullets to address the very complicated U.S. healthcare system - no one wants to limit/restrict access to needed healthcare. However, some form of disruption is needed along with a return to self-responsibility. Historically, any policy will result in consequences that favor some and disadvantage others. By not taking action we will all lose - similar to building muscle, some breakdown is necessary - in the end we will all be better by taking action.
I tell you a good disruption Rick Riley: break up insurance corporations vertical stranglehold on the health care economy.
Don’t leave it to doctors and hospitals to decide who gets care when patients can’t pay- find a solution.
Look at Germany for an example of a pluralistic health care economy that insures the entire nation. Yes, noncitizens too. And yes, to free enterprise , just they have 30+ insurance companies instead of 5 and they’re not allowed rapacious profit margins.
Our gang of 5 (Aetna/BlueCross/Cigna/Humana and United) is allowed 18% through our US medical loss ratio bullshit.
The disruption you seek does not have to mean disrupting care to patients- it could mean taxing the shit out of billionaires, or nationalizing insurance corporations.
I am 75 years old, low income, health issues, and live in fear of losing everything/ I literally cannot stand MAGA! I do not understand why Republicans do not want anyone to have healthcare, but spend billions on war, their tax cuts for the ultra-rich, and how they spend everywhere else, but take away healthcare, EBT, Medicare, Medicaid, and literally want to murder the poor by taking away healthcare. The costs of medicine and co-pays will force people to not go to the doctor. The lack of Meals on Wheels and EBT for the poor and elderly will create a mass genocide without ovens. I will die!
Speaking for someone who works with clients enrolling in individual market plans primarily on the Marketplace, the proposed changes are significant.
The most impactful Marketplace specific changes in our opinion (quotes are pulled from the KFF summary):
End to autorenewals: An end to autorenewals will mean every enrollee will need to be actively renewed for 2026. We push active renewals far harder than most brokers, so this will be less of a hit to us than others, but I'd expect around ~12% of our clients ignored all of the outreach encouraging active renewal and autorenewed this year. Especially for enrollees in this market for multiple years who are accustomed to their plan autoenrolling, there will be a ton of confused enrollees who either lose coverage altogether or lose their premium/plan subsidies come January.
"Requires that all premium tax credit recipients repay the full amount of any excess, no matter their income." This would be a complete removal of the repayment caps regardless of income (over or under 400% FPL). This will increase the amount of premium tax credit repayment for enrollees. Many are already afraid that they will get burned when they file if they accept the subsidies as an advance. Often I would explain how the caps work and that would effectively allay those fears. The end result will be less enrollees as some either artificially inflate their income projection leading to premiums too high for them to pay and others who decide not to enroll at all out of fear or subsidy repayment.
Also, only immigrants who are LPRs or “green card” holders would be eligible to enroll (significant reduction in who is eligible) and, of those, immigrants who are not eligible for medicaid due to not being legally present for 5 years would lose subsidy eligibility. We probably have 20-30 people in this group.
Of course, the loss of the covid-era/american rescue plan expanded premium subsidies is the biggest impact though that's not being caused by this bill specifically as they were designed to sunset at the end of 2025.
One positive: "Return to funding CSRs through payments from the federal government with explicit congressional appropriation of funds." This could reduce premiums in my state. It's bad for states that allowed "silver loading" which dramatically increased premium tax credits overall, but Indiana never allowed that.
Finally, most of these changes are set to kick in 1/1/26 which is outrageously soon given that carriers are filing rates for 2026 right now. If passed, HHS and the carriers will struggle to implement and provide notice of all of these changes by the start of OEP.
The current administration and Congress could find themselves in damage control mode by Christmastime or earlier. This is because of the combined financial strain from: sharply rising health insurance costs for individuals and the loss of medicaid benefits, the restarting and increasing burden of federal student loan payments throughout the fall, and market disruptions caused by tariffs and general ongoing regulatory uncertainty across all industries.
Unfortunately, there are no silver bullets to address the very complicated U.S. healthcare system - no one wants to limit/restrict access to needed healthcare. However, some form of disruption is needed along with a return to self-responsibility. Historically, any policy will result in consequences that favor some and disadvantage others. By not taking action we will all lose - similar to building muscle, some breakdown is necessary - in the end we will all be better by taking action.
I tell you a good disruption Rick Riley: break up insurance corporations vertical stranglehold on the health care economy.
Don’t leave it to doctors and hospitals to decide who gets care when patients can’t pay- find a solution.
Look at Germany for an example of a pluralistic health care economy that insures the entire nation. Yes, noncitizens too. And yes, to free enterprise , just they have 30+ insurance companies instead of 5 and they’re not allowed rapacious profit margins.
Our gang of 5 (Aetna/BlueCross/Cigna/Humana and United) is allowed 18% through our US medical loss ratio bullshit.
The disruption you seek does not have to mean disrupting care to patients- it could mean taxing the shit out of billionaires, or nationalizing insurance corporations.
We are not stuck with this system- we choose it.
Big problem…
1116 pages …
Passed by one vote..
I am 75 years old, low income, health issues, and live in fear of losing everything/ I literally cannot stand MAGA! I do not understand why Republicans do not want anyone to have healthcare, but spend billions on war, their tax cuts for the ultra-rich, and how they spend everywhere else, but take away healthcare, EBT, Medicare, Medicaid, and literally want to murder the poor by taking away healthcare. The costs of medicine and co-pays will force people to not go to the doctor. The lack of Meals on Wheels and EBT for the poor and elderly will create a mass genocide without ovens. I will die!
Call that healthcare?