House #Republicans proposing a $200B budget bill to fund #Iran War & #ICE operations by cutting federal #healthcare spending, using reconciliation process to bypass #Senate filibuster, resulting in 300,000 more uninsured.
#IranWar #ACA #SilverLoading
www.youtube.com/watch?v=BynD...
Metal Level "< 200% FPL" "200 - 400% FPL" "> 400% FPL" "Other/ Unknown" Total Catastrlphic 67,489 Bronze 4,498,450 3,444,341 635,644 573,484 9,151,919 Silver 8,300,211 1,202,334 171,015 173,713 9,847,273 Gold 2,295,459 1,169,890 219,172 283,768 3,968,289 Platinum 95,890 Total 15,094,120 5,816,565 1,025,831 1,030,965 23,130,860 Would BENEFIT from CSR reimbursement payments 171,015 Would be HARMED by CSR reimbursement payments 5,469,047
UPDATE: Full blog post to come, but here's what it looks like using *2026* enrollment data.
The number of #ACA enrollees who would *benefit* from CSR reimbursement payments being reinstated (ie, killing #SilverLoading) has DROPPED to perhaps ~170K.
The number who'd be HARMED is perhaps ~5.4M.
House Budget Committee Chairman Jodey Arrington (R-Texas) is reviving an idea that was considered last year to fund Affordable Care Act payments known as cost-sharing reductions. The Congressional Budget Office previously found the move would lower overall benchmark ACA premiums by 11% but result in 300,000 more uninsured people. It would have the effect of cutting the subsidy amount that some enrollees receive, thereby increasing out-of-pocket premium costs, while saving the government over $30 billion.
🚨🚨🚨 BINGO: CALLED IT, DAMMIT.
"funding Cost Sharing Reduction payments" is exactly what would kill #SilverLoading.
It would reduce *gross* premiums modestly but would result in ~300,000 more people losing coverage and dramatic premium hikes for millions more.
www.axios.com/2026/03/30/g...
For those wondering: While there's any number of additional areas of healthcare coverage they could be scheming to gut, my guess is the #1 item on their list will be to kill off #SilverLoading for #ACA enrollees.
acasignups.net/25/05/07/sil...
My guess: They're gonna go after #SilverLoading for ACA enrollees, for starters.
acasignups.net/24/01/05/my-...
In any event, CSR funding being eliminated in October 2017 led to #SilverLoading as an unintended consequence, and Silver Loading is a MAJOR part of the "Premium Alignment" pricing policies which over a dozen states now have in place:
acasignups.net/25/11/12/the...
Can I teach people how to go for three hours on #Silverloading
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...
IMPORTANT: The ~300,000 that the CBO projects to lose coverage due to #SilverLoading ending would be ON TOP OF the ~4M or so the CBO projects to lose coverage due to the enhanced tax credits expiring.
I've updated the headline at the link to try & make this more clear.
That's *specifically* due to the end of #SilverLoading alone.
That's in addition to the 4M+ expected to lose coverage due to the expiring tax credits.
IMPORTANT: The ~300,000 that the CBO projects to lose coverage due to #SilverLoading ending would be ON TOP OF the ~4M or so the CBO projects to lose coverage due to the enhanced tax credits expiring.
🚨 House GOP Bill: No #ACA tax credit extension after all; CBO projects 300K to lose coverage due to end of #SilverLoading in mostly red states:
acasignups.net/25/12/16/hou...
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.
This means that #SilverLoading would be ended in red states (and some purple/blue ones) but would continue in the following states:
CA, CO, IL, ME, MD, MA, MN, NJ, NY, OR, VT, WA.
You can read my explainer of #SilverLoading here.
Short version: It made *full-price* Silver plans more expensive but also made BRONZE and GOLD plans far *less* expensive in most states...to the point that some people can get them for $0/mo.
acasignups.net/24/01/05/my-...
Trump & the GOP thought ending these payments would severely damage the ACA; instead they actually ended up unintentionally *strengthening* it thanks to a clever pricing reaction by insurance carriers & state regulators called #SilverLoading which turned lemons into lemonade.
It's also important to understand that this would also eliminate #SilverLoading, which means GROSS premiums for ~1.6M middle-class enrollees would likely drop ~11%...but it would also cause NET premiums for around ~5.7M *low-income* enrollees to INCREASE, in many cases by 20-30% or so.
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.
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.
If you really want to understand why this is the case, here's my #SilverLoading explainer from a few years back.
Some states have fully embraced & are maximizing silver loading; others not so much.
acasignups.net/24/01/05/my-...
NOTE: If this family shops around they can knock that $722 down to $678/month *and* reduce their deductible by $3,000 to boot thanks to #SilverLoading.
They'd still be paying 88% more in premiums, but that's something...
Just finished building out the WHY I DON'T TRUST CHAT GPT for anything case example for class next week --- had 5 prompts on #Silverloading my CV, and my co-authors.
Every response had a material inaccuracy. Some were easy things to find out. Some required deep expertise to identify.
NEXT UP: HOUSEHOLD INCOME (200 - 400% FPL)
--25% (6.0 million) of #ACA enrollees earn 200-400% FPL
--They'll be hit w/a DOUBLE whammy: Not only will the IRA subsidies likely expire, so will #SilverLoading, meaning they'll be hit on both premiums *and* OOP costs!
acasignups.net/2025_oep/fin...
However, thanks to High AV CSR ( #SecretPlatinum ), over 75% of Mississippi enrollees actually have "Gold Or Better" coverage.
METAL LEVELS / GOLD+ COVERAGE WILL BE COMPLETELY HOSED IF THE IRA SUBSIDIES EXPIRE & #SilverLoading ENDS.
NEXT UP: NEW vs. RENEWALS:
-- 17% of all #ACA exchange enrollees are new
--39% actively re-enrolled; 45% passively re-enrolled
--That 45% will be a MAJOR PROBLEM THIS FALL given the likely expiration of IRA subsidies *and* the likely end of #SilverLoading
acasignups.net/2025_oep/fin...
In 2017, Trump spent 6 months vowing to "cripple the ACA" by cutting off CSR payments to insurance carriers before he finally actually did so.
Ironically, this backfired & ended up *strengthening* the ACA marketplaces when carriers & state regulators implemented #SilverLoading in response.
This is thanks to a pricing strategy known as
#SilverLoading (officially #PremiumAdjustment) which has been around since 2018 but which has become more widely used since then. Here's a simple explainer for those interested:
acasignups.net/24/01/05/my-...
Having said that, here's some of the major provisions of the #NBPP2026:
--major crackdowns on #ACA marketplace agent/broker fraud, which has been a growing problem recently
--FINALLY codifying #SilverLoading as an approved/blessed plan pricing methodology
This is thanks to a pricing strategy known as #SilverLoading (officially "#PremiumAdjustment) which has been around since 2018 but which has become more widely used since then. Here's a simple explainer for those interested:
acasignups.net/24/01/05/my-...
