Why a little-known state law may protect Texans from the biggest ACA cost spikes A state law has resulted in lower premiums on some of the Texas plans sold on Healthcare.gov, even as Republicans have decided not to extend subsidies next year.

HEY TEXAS ACA ENROLLEES: Here's an article about #SilverLoading & #PremiumAlignment which puts them in pretty easy-to-understand terms:

www.houstonchronicle.com/politics/tex...

Nesting Doll: Silver Loading inside of Switching inside of Premium Alignment

I should note that if #SilverLoading *is* ended, the 14 states with #PremiumAlignment policies in place will still have more affordable Gold & Bronze plans, it just won't be nearly as dramatic.

Silver Loading/Switching make up the bulk of Premium Alignment but not all of it.

Silver Linings Playbook: Some states are taking action to mitigate the upcoming tax credit tsunami (Update: Add MA to the list!) As anyone not under a rock for the past few months knows by now, the improved federal Affordable Care Act tax credits which were put into place by President Biden and Congressional Democrats starting ...

It's also worth giving a shout-out to states like CA, CO, NJ and others who are taking action to mitigate the damage.

In some cases this is via state-based subsidies; in others it's via leveraging the remaining subsidy formula to the hilt via #PremiumAlignment.

acasignups.net/25/10/14/sil...

No. #PremiumAlignment has nothing to do with state funding, it has everything to do with how the actuarial tables interact with the ACA itself and how the federal tax credits are structured.

Some of the states listed *also* have state-funded subsidies but that's separate from P.A. policy.

📣 ALSO IMPORTANT: There are 7 *other* states which haven't embraced #PremiumAlignment but which *do* have their own state-based subsidy programs or other programs in place to help lower-income enrollees, including...

📣 IMPORTANT: #PremiumAlignment is NOT A SUBSTITUTE FOR THE EXPIRING ENHANCED TAX CREDITS.

Even in states which have embraced it, it doesn't help *all* enrollees, and even among those it helps it doesn't necessarily cancel out all of the damage.

It does, however, help a lot for a lot of people.

Arkansas

Next up: #ARKANSAS, which some of you may recall I got a bit obsessed with tracking a couple of months ago.

Arkansas is one of the states NEWLY implementing #PremiumAlignment for 2026, *directly* in response to the enhanced tax credits expiring.

This results in an odd-looking pricing pattern...

Alaska

First up: #ALASKA (also the income exception...the Federal Poverty Level is 25% higher in AK, so I put the income 25% higher as well)

AK has had #PremiumAlignment for years, so Bronze, Silver & Gold are all going up...but Gold still cost an avg. of 28% LESS than Silver after subsidies are applied.

With that in mind, here's the 14 states which DO have #PremiumAlignment policy in place...some of which may surprise you!

CAVEATS:

--They assume a 50-yr old single adult
--They assume an annual income of $50K/yr (w/one exception)
--They assume the enrollee lives in the capital city of that state

Michigan

Before I dig in, here's what you'd *normally* expect #ACA plan pricing to look like, using my home state of #MICHIGAN, which (unfortuantely) has NOT instituted #PremiumAlignment yet:

For both years, Bronze plans cost the least, Silver costs more and Gold costs the most. Seems obvious, right?

Premium Alignment, or how a dozen states are quietly providing ACA enrollees w/better options even in the face of expiring tax credits I've written multiple times in the past about "Silver Loading," the ACA health insurance policy pricing strategy in which insurance carriers load the extra cost of their Cost Sharing Reduction financi...

Last week I explained how wonky stuff like #SilverLoading and #PremiumAlignment have been used by some states to significantly *reduce* the price of GOLD and BRONZE plans while simultaneously boosting the amount of federal subsidies which can be used to buy them.

acasignups.net/25/11/06/pre...

I should note that plenty of other states have embraced #SilverLoading, which is sort of a weaker version of #PremiumAlignment, so folks should check out Gold plans anyway to see if they’re a better value even if they aren’t an *amazing* deal.

Nationally there's around 6 million #ACA enrollees who earn 200 - 400% FPL.

Only about 1.5 million of them live in states which have #PremiumAlignment in place next year, however.

HOWEVER, if you earn 200 - 400% FPL *and* live in a state which has embraced #PremiumAlignment, I *strongly* urge you to consider comparing GOLD plans (or Bronze) vs. Silver.

You may find that the Gold plan--which you'd expect to cost more since it has lower deductibles/co-pays/etc--costs less.

NOTE: #PremiumAlignment does NOT cancel out the damage caused by the tax credits expiring.

It won't help those > 400% FPL next year since they won't be eligible for tax credits at all.

It won't help most < 200% FPL since they're usually still better off staying with Silver thanks to the CSR help.

Little Rock, Arkansas: Range of net ACA premiums for a 50-yr old adult earning $50K/yr by metal level in 2025 & 2026

By contrast, here's what it looks like in Little Rock, Arkansas, which is newly-implementing #PremiumAlignment.

Net Silver premiums go up dramatically--but Bronze and Gold *drop* dramatically, meaning you can get a dirt-cheap Bronze or a much less-expensive Gold plan.

Michigan: Range of net ACA plan premiums in Lansing for a 50-yr old adult earning $50K/yr in 2025 vs 2026 by metal level

Here's what this looks like in practice. Here in Michigan, which ISN'T embracing #PremiumAlignment yet (I've been trying to get it through for 2 years now), the NET price (after tax credits) of Bronze, Silver *and* Gold plans are all increasing significantly next year, as you might expect.

If you've read my posts about #SilverLoading in the past, this is related to that but takes it one step further. It's perfectly legal and is actually more in line with how the #ACA itself was actually worded.

Some states have been using #PremiumAlignment for years now; 3 more are doing so in 2026.

It gets wonky, but the bottom line is that a dozen or so states (including both deep blue & deep red ones) have implemented a pricing policy called #PremiumAlignment which has the effect of dramatically reducing NET premiums on Bronze & Gold plans without negatively impacting most Silver enrollees.

Some states have gone the extra mile (or are about to do so starting in 2026) with full-blown #PremiumAlignment, which gets even wonkier but boils down to a pricing strategy which maximizes the federal tax credit dollars as much as possible for enrollees.

familiesusa.org/wp-content/u...

Washington State also jumps on the Premium Alignment bandwagon to mitigate tax credit expiration I just finished writing up a deep dive into the Arkansas Insurance Dept's move from laissez faire-style Silver Loading to fully-regulated & maximized Premium Alignment in an attempt to mitigate the ma...

WASHINGTON STATE jumps on the #PremiumAlignment bandwagon to mitigate tax credit expiration impact

(WHEN WILL MY HOME STATE OF MICHIGAN DO THE SAME??)

acasignups.net/25/09/15/was...

EXCLUSIVE: Arkansas Insurance Dept. going all in on Premium Alignment...but are they overplaying their hand? Warning: This isn't just gonna get deeply wonky, it also requires digging deep into histroy. You've been warned. Chapter 1: The (simplified) Backstory: The ACA includes two types of financial subsidie...

📣📣📣 AS PROMISED: A deep, wonky dive into what #Arkansas is doing to counter the pending enhanced #ACA tax credit expiration.

In short, they're fully embracing #PremiumAlignment (as some states already are & every state should be).

HOWEVER...I still have questions...

acasignups.net/25/09/15/exc...

7/N Small group varies between states. There is a big downward trend as groups move from fully insured ACA plans to self-insured/ERISA level funded plans. But I think this reflects some impact of policy and outcomes (Sec 1332, SBM, Medicaid Expansion, depolarization #PremiumAlignment etc)

Illinois: HUGE! Healthcare Protection Act passes; step therapy & I've been following this bill for awhile now but never got around to writing about it until after it passed through both chambers of the Illinois legislature. That's a shame, because it's a pretty

📣 ILLINOIS: BOOM! Healthcare Protection Act passes both chambers; bans step therapy & prior authorization, mandates #PremiumAlignment, mandatory network audits & more!!

acasignups.net/24/05/28/ill...

Vermont: (Preliminary) avg. unsubsidized 2025 #ACA rate change: And here...we...go... Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the

VERMONT: (preliminary) avg. unsubsidized 2025 #ACA rate changes: +14.9%...but say hello to #PremiumAlignment!

acasignups.net/24/05/16/ver...