ACA Compacts For Interstate Insurance Sales: How Much Flexibility Do They Provide? (Part 2) | Health Affairs Forefront In part 1 of this article, we discussed the history of and legal issues regarding the interstate sale of insurance and sec. 1333 of the ACA. In part 2 below, we outline our view of what sec. 1333 can ...

In a two-part series for Health Affairs Forefront, @solomonctryls.bsky.social Senior Fellow @jasonlevitis.bsky.social and his co-author discuss the legal and practical limits of efforts to allow ACA Marketplace plans to sell health insurance across state lines. www.healthaffairs.org/content/fore...

Reupping this readers' guide in case details emerge over the weekend.

A key litmus test: “operationalizing changes in Marketplace policy requires months to build…Establishing and transferring funds to health savings accounts (HSAs) would take even longer. Fortunately, Marketplaces have already built IT systems for a “clean” extension [to switch] “on” in…days”

Statement of Jason Levitis Before the Senate Finance Committee In his testimony, entitled "The 2026 Health Care Affordability Cliff and the Costs of Health Care Complexity," Levitis discussed how the Marketplace pr…

And more on the issue is in my recent Senate Finance Committee testimony.

www.urban.org/research/pub...

Damage from Inaction on ACA Tax Credits Has Begun and Will Grow with Further Delays A key sticking point in ongoing negotiations to fund the government is upcoming reductions in the premium tax credit (PTC). While some claim that negotiation…

Here's a piece explaining the timing.

www.urban.org/research/pub...

Six Questions to Evaluate the White House’s Proposal to Extend Affordable Care Act Enhanced Premium Tax Credits With consumers already seeing higher premiums from imminently expiring enhanced premium tax credits, federal policymakers will need to ensure that any plan c…

As we 👀 for the White House plan to extend ACA tax credits, here's a readers' guide with 6️⃣ key questions to ask.

The first and most important: does it quickly halt the growing harm from 2026 premium increases hitting consumers NOW with open enrollment in full swing?

www.urban.org/urban-wire/s...

Statement of Jason Levitis Before the Senate Finance Committee In his testimony, entitled "The 2026 Health Care Affordability Cliff and the Costs of Health Care Complexity," Levitis discussed how the Marketplace pr…

Today, Urban Institute senior fellow Jason Levitis testified at a Senate Finance Committee hearing on addressing the affordability cliff and the costs of #healthcare. See what the #research shows on how losing #ACA enhanced PTCs will impact coverage for millions.

Expanding Health Savings Accounts Would Do Little to Improve Access to Affordable Health Care Amid the urgent debate over whether Congress will act to prevent cost increases for millions of people in 2026 marketplace plans, some Republicans are promoting expansions of health savings accounts.....

HSAs are tax shelters masquerading as health policy. They don't help people who are struggling to afford health coverage.

Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx

The Pointless Proliferation Of Tax-Preferred Health Spending Arrangements, Part 1: The Landscape | Health Affairs Forefront This piece highlights a striking example of pointless complexity in the US health care system: the 24 (or more) separate tax-preferred, account-based health spending arrangements. Part 1 surveys the l...

A few more possibilities...

www.healthaffairs.org/content/fore...

Eligibility Cliff on ACA Tax Credits Would Make Health Care Unaffordable for Middle-Class Families A key sticking point in the government shutdown debate is the upcoming reductions in the premium tax credit (PTC), particularly how the credit declines as in…

For more information on how enhanced PTCs help older people, people in high-premium areas, small businesses, etc., check out these papers.

www.urban.org/research/pub...

www.urban.org/research/pub...

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Younger people are not immune from this logic, especially in high-premium areas, which include many rural areas. A $10K FSA is a pittance towards the cost of a complex pregnancy or serious workplace accident. 4/

Not that all older people see such hardships. But if you do, costs can easily run to $100Ks. This FSA proposal leaves you medically bankrupt. What you need is something that pays more if you have large expenses, so the maximum benefit exceeds the average cost. There's a name for that: insurance. 3/

With enhanced PTCs, the 63yo’s out-of-pocket premiums are capped at about $460/mo. This means PTCs are maybe $10K or $15K/yr, depending on local premiums. But if that $10K or $15K goes into an FSA and the 63yo is uninsured, the FSA is not nearly enough for a heart attack or cancer or broken hip. 2/

With the mini-burst of proposals to replace enhanced PTCs with spending accounts like FSAs, keep in mind that this would *absolutely wallop* older people with middle incomes—say a 63-year-old earning $65K—who are among the most dependent on enhanced PTCs. 🧵1/

Eligibility Cliff on ACA Tax Credits Would Make Health Care Unaffordable for Middle-Class Families A key sticking point in the government shutdown debate is the upcoming reductions in the premium tax credit (PTC), particularly how the credit declines as in…

In a new @urbaninstitute.bsky.social issue brief, @solomonctryls.bsky.social Senior Fellow @jasonlevitis.bsky.social and his co-authors explain that if Congress lets enhanced ACA tax credits expire, it will reimpose a steep eligibility cliff for middle-income earners. www.urban.org/research/pub...

Health Affairs Journal

🏥 Writing for Health Affairs Forefront, @solomonctryls.bsky.social and @urbaninstitute.bsky.social senior fellow @jasonlevitis.bsky.social and his co-authors explain that Congress’s delay in extending ACA subsidies has already increased costs for consumers. www.healthaffairs.org/content/fore...

4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire In this brief, we estimate the impact on coverage of the expiration of enhanced PTCs that would occur in 2026 without action by Congress. Our estimates inclu…

📈 In a new @urbaninstitute.bsky.social report, @solomonctryls.bsky.social Senior Fellow @jasonlevitis.bsky.social and his co-authors project that millions more people will be uninsured if Congress lets enhanced premium tax credits for ACA Marketplace plans expire. www.urban.org/research/pub...

"[T]he US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect." Always read @mattafiedler.bsky.social. www.healthaffairs.org/content/fore...

Reconciliation Bill and End of Enhanced Subsidies Would Cut Health Care Provider Revenue and Spike Uncompensated Care The House of Representatives passed, and the Senate is now negotiating, a budget reconciliation bill that would impose federal funding cuts on Medicaid and the ACA Marketplaces.

Health care providers would lose $1 trillion in revenues and uncompensated care would increase $278 billion between 2025-34 due to House Republican reconciliation bill and expiration of premium tax credits. (1/3) www.urban.org/research/pub...

The Sleeper Provision in the Reconciliation Bill That Could Hobble the ACA Marketplaces An obscure provision in the U.S. House reconciliation bill could have major consequences for the Affordable Care Act Marketplaces. In a guest post for CHIRblog, the Urban Institute's Jason Levitis and...

Does the House GOP reconciliation bill take health insurance away from newborn babies? Why yes, yes it does. If you read nothing else today, read this post from CHIRblog guest authors @jasonlevitis.bsky.social and @clinkeyoung.bsky.social chirblog.org/the-sleeper-...

Another technical note is that this score includes only 1/2 the effects of the E&C piece codifying the Marketplace proposed rule, per normal CBO practice and this email they sent to staff. So relative to current law, it's another .95M.

democrats-waysandmeans.house.gov/sites/evo-su...

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In other words, the proposal would reduce APTC and increase out-of-pocket premiums.

Beyond MOOPs, under IRS regs, the PAP is used to update individual contributions for consumers getting APTC. So assuming the IRS adopts the new PAP as usual, APTC recipients will pay about 4.5% more for a benchmark plan.

Also explained here:

www.shvs.org/recent-feder...

CMS's proposed #ACA marketplace rule would mean fewer people with health coverage, more red tape, higher costs, less time to enroll, plus decreased access for certain groups. People currently struggling to afford the basics would once again lose out. Some highlights (lowlights?) - a 🧵:

Key GOP votes withhold support from House plan despite Trump’s backing Three key House moderates told The Hill on Wednesday that they are still not on board with the chamber’s budget resolution, even after President Trump endorsed it earlier in the day. Reps. David Va…

Plus Bacon makes nine.

thehill.com/homenews/hou...

Letter to Speaker Johnson opposing #Medicaid and SNAP cuts in budget resolution led by Rep. Gonzales (TX) and signed by other GOP members including Valadao (CA) Malliotakis (NY) De La Cruz (TX) Ciscomani (AZ) and Bresnahan (PA) who are part of the Republican Congressional Hispanic Conference.

Considerations for a Potential State-Based Marketplace in Texas This study summarizes and analyzes perspectives on a potential Texas transition to an SBM, including risks and benefits, best practices to mitigate risks to coverage if Texas elects to establish an SB...

In their next session, TX lawmakers may again consider leaving the federal Marketplace and transitioning to a state-based Marketplace. Our new report finds that stakeholders who would be most directly affected uniformly worried that risks outweighed potential benefits. www.urban.org/research/pub...

Considerations for a Potential State-Based Marketplace in Texas This study summarizes and analyzes perspectives on a potential Texas transition to an SBM, including risks and benefits, best practices to mitigate risks to coverage if Texas elects to establish an SB...

New from @jasonlevitis.bsky.social and colleagues at @urbaninstitute.bsky.social
Shifting to a state based Marketplace comes with opportunities and risks, but those who would be most directly
affected believe that the risks outweigh the likely benefits.
#healthpolicy
www.urban.org/research/pub...

@urbaninstitute.bsky.social has a great interactive out this week on what losses might look like by state: www.urban.org/data-tools/h...