Navigating New Coverage Changes: What People With Diabetes Need to Know
On Thursday, September 18, 2025 Georgetown University’s Center on Health Insurance Reforms (CHIR) ...
Posts categorized as: Affordable Care Act and Marketplaces
Events:
News:
The shutdown is about to end. Will millions lose their health insurance?
The uncertainty and concerns about affordability will likely prompt some cost-conscious and healthier consumers to drop ACA coverage.
Publications:
What Health Insurance Risk Pooling Is, and Why It’s Key to Maintaining Affordability
This explainer describes how health insurance risk pooling works and explains how recent federal policy changes — including Medicaid cuts under H.R. 1, the expiration of enhanced ACA premium tax credits, reduced marketplace enrollment, and regulations lowering the value of coverage — will shrink insurance risk pools, raise premiums, and shift costs onto sicker Americans.
What Consumers Need to Know About Health Coverage That Doesn’t Comply with the Affordable Care Act
As Trump administration policies and Congressional inaction on enhanced premium tax credits make ACA marketplace coverage harder to access and afford, this publication explains what consumers need to know about the risks of alternative coverage arrangements — including short-term plans, health care sharing ministries, fixed indemnity insurance, and Farm Bureau plans — that lack the ACA's core consumer protections.
Health Care Costs for Small Employers: Analysis of Market Challenges and Policy Solutions
In this report, researchers partnered with health actuaries at Wakely Consulting Group (Wakely) to assess the current state of the market for small employer health insurance, the factors driving its decline, and the scope of potential policies to improve coverage affordability for small businesses and their workers.
Recommendations for States’ Efforts to Mitigate Harms Caused by Federal Policy Actions
This report provides a set of recommendations for states to mitigate the loss of health insurance coverage resulting from federal policy changes.
The Crucial Role of $0 Premium Plans in the Affordable Care Act Marketplaces
CHIR fact sheet summarizes available evidence on the impact of $0 premium Marketplace plans on health insurance coverage and premiums.
New Trump Administration Policies Weaken the Health Insurance Marketplace for Consumers — Including Workers Who Shop on Their Own
This article discusses Individual Coverage Health Reimbursement Arrangements (ICHRAs) and explains how new federal policy changes that threaten the stability of the ACA marketplaces undermine ICHRAs as a coverage option for small businesses and their employees.
New Federal Policies Spur Higher Health Insurance Premiums for Consumers in 2026, Insurer Filings Show
This article reviews insurer rate filings to show how federal policy changes, including the pending expiration of enhanced premium tax credits, are making ACA marketplace premiums much more expensive.
Congress and the Administration Are Using Paperwork to Discourage Enrollment in Marketplace Insurance
This article explains how President Trump’s domestic policy law and new regulations are creating red tape and administrative barriers to enrolling in the ACA marketplaces, reducing access to affordable health coverage.
Trump Administration and Congress Reduce Federal Health Spending at the Expense of States, Consumers, and Millions of Newly Uninsured
This article explains how new federal policies are making big changes to how the ACA marketplaces operate, imposing costs and burdens on states and consumers in ways that will make coverage harder to access and afford.
Dental Coverage Through the Marketplace: A 2024 Snapshot of Enrollment, Market Participation and Premiums
This data snapshot reviews 2024 dental coverage in the ACA Marketplaces, highlighting trends in enrollment in pediatric and adult stand-alone dental plans, insurer participation, and premiums across states.
A New Rule to Limit ACA Enrollment Periods May Deter Sign-Ups and Worsen Risk Pools
This article analyzes how proposed limits on ACA enrollment periods could reduce sign-ups and destabilize the individual health insurance market risk pool.
New Administration Plans to Reinstate Cuts to Funding for ACA Outreach and Enrollment Assistance
This article discusses the Trump administration’s 90 percent funding cut to the organizations that provide outreach, education, and enrollment assistance for people using the federal ACA marketplace, HealthCare.gov.
Policymakers Can Protect Against Fraud in the ACA Marketplaces Without Hiking Premiums
This article discusses options for reducing broker misconduct and fraud in the ACA marketplaces, including suggestions by conservatives to address broker problems by eliminating the enhanced premium tax credit for consumers.
Report Shows Dispute Resolution Process in No Surprises Act Favors Providers
This article analyzes evidence showing that the No Surprises Act’s dispute resolution process may advantage health care providers over insurers.
States Forge Ahead to Protect Consumers, as Advisory Committee Recommends Federal Action on Surprise Ambulance Bills
This article examines state efforts to protect consumers from surprise ambulance bills and recent recommendations for federal legislative solutions.
How States Can Use Tax and Unemployment Filings to Sign People Up for Health Insurance
This article explains how states are establishing “check the box” programs using state tax and unemployment forms to facilitate enrollment in ACA marketplace coverage.
Raise the Bar: State-Based Marketplaces Using Quality Tools to Enhance Health Equity
This article examines how state-based ACA marketplaces are using quality measurement and oversight tools to advance health equity and improve consumer outcomes.
Expanding the No Surprises Act to Protect Consumers from Surprise Ambulance Bills
This article outlines policy options to extend federal No Surprises Act protections to address surprise bills by ground ambulance services.
States Expand Access to Affordable Private Coverage for Immigrant Populations
This article reviews state policies that improve access to affordable private health insurance for immigrant communities.
If Expanded Federal Premium Tax Credits Expire, State Affordability Programs Won’t Be Enough to Stem Widespread Coverage Losses
This analysis finds that state-funded subsidies cannot offset cost increases and coverage losses if enhanced federal ACA premium tax credits expire.
Enhancing Essential Health Benefits: How States Are Updating Benchmark Plans to Improve Coverage
This issue brief describes how states are updating ACA benchmark plans to expand covered benefits and improve consumer protections.
What States Are Doing to Keep People Covered as Medicaid Continuous Enrollment Unwinds
This article reviews state strategies to prevent coverage losses as Medicaid eligibility redeterminations resume after the pandemic, focusing on efforts that leverage the ACA marketplaces.
Health Care Sharing Ministries Leave Consumers with Unpaid Medical Claims
This article discusses data from Colorado that shed light on the operations and finances of health care sharing ministries (HCSMs) and the potential risks to consumers.
State Public Option Plans Are Making Progress on Reducing Consumer Costs
This article examines early evidence from Colorado and Washington’s public options, the Colorado Option and CascadeCare, about whether those programs are containing health care costs and premiums.
State Health Equity Initiatives Confront Decades of Racism in the Insurance Industry
This article explores state-led initiatives aimed at addressing structural racism and advancing equity in health insurance markets.
Biden Administration Sets Limits on Use of Short-Term Health Insurance Plans, But States Can Do More to Protect Consumers
This article analyzes new limits on short-term plans set by the Biden administration and highlights additional actions states can take to protect consumers.
Coverage of Preventive Services Without Cost Sharing in Jeopardy as Texas Court Strikes Down ACA Protection
This article explains how a federal court ruling threatens no-cost preventive care coverage under the ACA and outlines state responses to help preserve access.
States Act to Strengthen Surprise Billing Protections Even After Passage of No Surprises Act
This article reviews how states continue to enhance surprise billing protections for consumers following enactment of the federal No Surprises Act.
Uneven Ground: Differences in Language Access Across State-Based Marketplaces
This issue brief analyzes variation in language access policies across state-based marketplaces and their implications for equitable coverage access.
Policy Innovations in the Affordable Care Act Marketplaces
This issue brief describes how state-run ACA marketplaces are using flexibility to adopt policies designed to reduce administrative burdens, help consumers navigate health plan options, require or incentivize insurer participation, and reduce health and coverage disparities.
States Move Forward with Public Option Programs, but Differ in How They Select Insurance Carriers
This article reviews how states implementing public option programs vary in their approaches to selecting participating insurers.
State Telemedicine Coverage Requirements Continue to Evolve
This article analyzes how state telemedicine coverage policies are changing and what those changes mean for access to care.
Implementing the Family Glitch Fix on the Affordable Care Act’s Marketplaces
The “family glitch” was a policy that had left about 5 million low-income Americans ineligible for affordable ACA marketplace coverage; this article explains a Biden administration rule addressing this problem.
The ACA’s Preventive Services Benefit Is in Jeopardy: What Can States Do to Preserve Access?
This article examines legal threats to the federal requirement for insurers to cover high-value preventive services and the policy tools states can use to maintain access.
Congressional Proposals for a Federal Public Health Insurance Option
This article summarizes federal legislative proposals for a public health insurance option and their potential impact on coverage and costs.
No Surprises Act: A Federal–State Partnership to Protect Consumers from Surprise Medical Bills
This report explores the varying approaches states have taken to enforce the consumer protections in the No Surprises Act and explains that the law will depend on effective federal–state partnerships as well as education for consumers and providers.
Using Health Insurance Reform to Reduce Disparities in Diabetes Care
This article discusses how health insurance reforms can be leveraged to improve access to diabetes care and reduce racial and socioeconomic disparities.
HHS Approves Nation’s First Section 1332 Waiver for a Public Option–Style Health Care Plan in Colorado
This article describes Colorado’s ACA 1332 innovation waiver, which helps the state implement a quasi-public option called the Colorado Option.
Improving Race and Ethnicity Data Collection: A First Step to Furthering Health Equity Through the State-Based Marketplaces
This article explains why better race and ethnicity data collection is critical for state-based marketplaces seeking to advance health equity and improve consumers’ access to care.
California’s Marketplace Tries New Tactics to Reduce the Number of Uninsured and Underinsured
This article discusses several policy initiatives from Covered California, including programs that eliminate nominal premiums and facilitate marketplace enrollment for people transitioning from California Medicaid, Medi-Cal.
Update on State Public Option-Style Laws: Getting to More Affordable Coverage
This article reviews developments from Colorado, Washington, and Nevada as these states work to establish public option–style programs aimed at lowering health care costs.
Massachusetts Data on Health Care Sharing Ministries Reveal Finances That Put Consumers at Risk
This article analyzes Massachusetts data showing financial instability and consumer risks associated with health care sharing ministries (HCSMs).
Ensuring the Adequacy of ACA Marketplace Plan Networks
This article discusses proposed rules by the Biden administration that would restore federal oversight of ACA marketplace plans’ provider networks and establish network adequacy standards.
State-Based Marketplace Outreach Strategies for Boosting Health Plan Enrollment of the Uninsured
This issue brief presents findings from a survey of state-based ACA marketplaces regarding advertising, outreach and enrollment strategies for open enrollment.
Blog Posts:
Fact Sheet: The Proposed Marketplace Rule Would Make Health Care Less Affordable and Add Red Tape
In February 2026, CMS published the proposed 2027 Notice of Benefit and Payment Parameters, which se...
What’s Worse than a Ghost Network Plan? A No-Network Plan
The Trump administration is promoting a new type of health plan that may have lower premiums, but in...
Proposed Marketplace and Insurance Changes in the 2027 Notice of Benefit & Payment Parameters: Implications for States
The Trump administration has proposed a sweeping set of policy and operational changes for the Affor...
Clues in State Data Suggest Declines in Early Marketplace Enrollment Data May Be Just the Tip of the Iceberg
Early open enrollment data provide a glimpse into how consumers are responding to increased premiums...
Recommendations for States’ Efforts to Mitigate Harms Caused by Federal Policy Actions
Recent federal policy changes will result in millions of people losing health insurance coverage. CH...
September-October Research Roundup
This fall, as leaves changed, election season heated up, and open enrollment approached, we dove int...
Cash is No Substitute for Coverage: Why Health Insurance Matters
As Congress ends the government shutdown, the debate over extending enhanced premium tax credits rem...
Recent Federal ACA Marketplace Changes Strip Access to Health Care for Many Lawfully Present Immigrants
For many lawfully residing immigrants, recent federal policy changes have effectively eliminated aff...
What to Expect for Open Enrollment, 2026 Edition
Debates over premium tax credits have dominated headlines, but other federal changes will also shape...
Damage From Inaction On ACA Tax Credits Has Begun And Will Grow With Further Delays
2026 ACA premium rates have shown sharp cost increases and coverage losses. In their latest piece fo...
The Crucial Role of $0 Premium Plans in the Affordable Care Act Marketplaces
As Americans struggle with health care affordability, federal policy changes have enabled many to ac...
Congress and the Administration Are Using Paperwork to Discourage Enrollment in Marketplace Insurance
Since taking office, the Trump administration has pursued multiple tactics to limit access to afford...
How States Can Help Curb the Rising Medical Debt Related to Federal Coverage Cuts
The budget reconciliation bill, combined with expiring enhanced premium tax credits and other recent...
Preventive Services at Risk: Federal Instability and State Responses
Although the Supreme Court recently upheld the constitutionality of the Affordable Care Act's mandat...
August Research Roundup
This August, between summer weekends and back-to-school prep, CHIR dug into fresh health policy rese...
New Guidance Expands Pool of Individuals Eligible to Purchase Catastrophic Plans
New federal guidance expands eligibility for "catastrophic" health plans that offer lower premiums b...
CHIR Submits Analysis to U.S. Senators on Double-Digit Rate Increases Proposed for the Marketplace in 2026
In August, 16 U.S. Senators asked CHIR to review health insurers’ filings to state regulators supp...
After H.R.1, Millions More Could Lose Marketplace Coverage
Marketplace enrollees are facing threats to their health coverage and healthcare affordability as a ...
Ruling in Challenge to Marketplace Rule: Initial Analysis and Implications for States
On August 22, a federal court blocked major provisions of a regulation affecting the Affordable Care...
The Dismantling of Obamacare Starts August 25 – Unless Litigation Can Stop It
The first of numerous federal policies that reverse recent coverage gains under the the Affordable C...
New Federal Rules Affecting Coverage of Treatment for Gender Dysphoria: Considerations for States
New federal rules attempt to curtail insurance coverage of treatment for gender dysphoria. In her la...
H.R. 1, Recently Enacted Federal Budget Law Spells Trouble for Patients with Insulin-Requiring Diabetes
The recently enacted federal budget law is set to significantly roll back health insurance coverage ...
Kentucky Drops Adult Dental Care from State’s Essential Health Benefits Benchmark Plan Submission
The 2025 Notice of Benefit and Payment Parameters gave states the flexibility to require adult denta...
June-July Research Roundup: Anticipated Effects of H.R. 1 on health insurance coverage, affordability, and uncompensated care
President Trump recently signed into law some of the most dramatic changes to our healthcare system ...
Explainer: The Medicaid and Marketplace Provisions of the Budget Reconciliation Bill
With the recent signing of H.R. 1, many may be wondering what this means for their Medicaid and Mark...
Final Federal Marketplace Integrity Rule: Implications for States
Recent federal rules are projected to cause up to two million people to lose health insurance and ra...
A Setback, Not a Defeat: Our Work to Ensure Access to Affordable, High Quality Health Care Continues
President Trump’s signature on H.R. 1, the budget reconciliation bill, will lead to upwards of 17 ...
Explore the Data: Interactive Map of Dental Coverage Through the Marketplaces
Dental coverage offered through the ACA Marketplaces is constantly changing. Building on CHIR’s 20...
Testimony of Sabrina Corlette, J.D. before the U.S. House of Representatives Ways & Means Health Subcommittee – June 25, 2025
The U.S. House of Representatives’ Ways & Means Health Subcommittee recently held a hearing about ...
Early 2026 Rate Filings Show Marketplace Policy Changes Contribute to Eye-Popping Rate Increases
This year, insurers are setting their rates for 2026 while Congress and the administration weigh sev...
Second Verse, Same as the First: Senate Reconciliation Language Fails to Fix Paperwork Burdens, Other Barriers to Marketplace Coverage
With the passage of H.R.1, the House of Representatives’ version of the budget reconciliation bill...
Federal Efforts Ostensibly Aimed at Marketplace “Fraud” Ignore Obvious Strategies to Counter Broker Misconduct
The proposed Marketplace Integrity rule and House-passed budget bill purportedly aim to curb ACA fra...
Congress’ Proposed Paperwork Requirements Could Leave New Families, Laid-off Workers, and Self-Employed Without Health Coverage
The Senate will soon consider the “One Big, Beautiful Bill” that would make changes to Marketpla...