President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010. We have been operating using either the national or state healthcare exchanges ever since. A major question at that time was whether it would be successful. We have the answer.
The ACA Marketplace has seen continuous growth, reaching a record high of 24 million individuals with insurance through the Marketplace in 2025. Literally, a life-saving opportunity affording Americans with preexisting conditions an opportunity to be insured at a cost they can afford. The Marketplace also provides an avenue for individuals and families who have limited income to afford quality insurance coverage.
So, what do you do with a wildly successful program that is servicing 24 million Americans? Well, you fail to support one of the critical features of the ACA. The premium tax credits (also known as subsidies), which lower the cost of health insurance premiums for eligible individuals and families ends in 2026. The recently passed Continuing Resolution to fund government operations fails to reauthorize these subsidies.
Even if the Congress acts in the next 30-days, there will be disruption.
So, what are they talking about to take the place of the Marketplace in the interim? “President Donald Trump’s exhortations that Congress should send money directly to households, rather than subsidize insurance premiums, loosely fits into the HSA framework, and GOP lawmakers are floating specific proposals. But other ideas are proliferating, including phasing out the ACA itself and reviving policies that didn’t make it into Trump’s tax law.” [Modern Healthcare]
The next 180 days will be interesting. The realities of increases in insurance premiums for 2026 have hit. The average increase for 2026 ACA Marketplace health insurance premiums is 26%, though this can vary by state, with those using Healthcare.gov seeing an average 30% increase and those in states with their own marketplaces seeing an average 17% increase. The median proposed premium increase is 18%, and these averages do not account for potential increases in what individuals will pay if enhanced premium tax credits expire (which they have).
So, again, with no plan for replacing the ACA in place, HSAs?
So, who is going to be impacted by this change? Americans with limited income will definitely be impacted. From carrying their own insurance card and being able to access the healthcare system for their care, to now having their access limited. Hospital charity and uncompensated care will grow as an estimated 1,000,000 Florida residents will be unable to afford coverage without subsidies. Like COVID, care will be delayed leading to more serious healthcare issues in the future.
We will keep you informed over the next few months about what is happening to either reauthorize the ACA of create a successful replacement.
