By CHIR Faculty; Prepared by Sabrina Corlette, Georgetown Center on Health Insurance Reforms, Jason Levitis, the Urban Institute, and Tara Straw, Manatt Health
On May 15, 2026 the Centers for Medicare & Medicaid Services (CMS) released a final set of annual regulations governing the Affordable Care Act (ACA) Marketplaces and insurance reforms. Despite a brief 30-day comment period, the proposed rule received over 5,000 comments. The final rule contains several new policies and operational expectations for state insurance regulators and State-Based Marketplaces (SBM), implements certain provisions of H.R.1, the 2025 budget reconciliation law, changes several current policies, and revisits the Marketplace Integrity final rule. Combined, the provisions of the final rule are projected to reduce Marketplace enrollment by 1.2 to 2 million people and lower federal spending on premium tax credits (PTC) by up to $10.15 billion in 2027.
In their latest regulatory analysis, CHIR Faculty Sabrina Corlette, the Urban Institute’s Jason Levitis, and Manatt Health’s Tara Straw break down the differences between the proposed and final rules, and what the final rule means for SBMs and state insurance regulators.