Jennifer Sullivan

Reports that the White House is working on a proposal to extend premium tax credit enhancements shows the Administration is acknowledging the urgent need to address premium spikes for millions of marketplace enrollees. But big questions remain.🧵

My colleague @nicolerapfogel.bsky.social summarizes the latest GAO report on health savings accounts. HSAs simply aren't a good fit for people with low incomes or serious health conditions.

Proposals to push ppl into plans w/high deductibles and out of pocket costs would simply increase the risk that they forgo needed care or face medical debt.

Three quarters of ACA enrollees have income at/below 250% FPL (~$38k for an individual), leaving little room to pay expensive medical bills out of pocket, let alone stash savings away in an HSA. www.cbpp.org/media/market...

The silver plan also comes with a much lower deductible ($700) and out of pocket cap ($3,300), providing additional protections for people who end up needing more care.

A silver plan with cost-sharing reductions is more affordable for someone at 200% FPL. In New Orleans, they could get a plan with predictable, pre-deductible copays of $10-$40 for different kinds of office visits, urgent care, and generic medications.

This bronze plan comes with a $6.5k deductible. After that, ppl still have to pay 40% of the cost of all their health care other than preventive up to the $10.6k cap. These costs would put health care out of reach—especially for ppl w/low incomes, who get reduced cost sharing with a silver plan.

Details are scarce. But we know a bronze ACA plan + a few thousand dollars in an HSA would not even cover the deductible for most bronze plans, let alone begin to make the cost of getting health care affordable. Take this 2026 plan available through HealthCare.gov to people in New Orleans.

Some recent Republican responses to the marketplace premium tax credit issue would shift more people to bronze plans with Health Savings Accounts as an alternative to silver plans with PTC enhancements and cost sharing reductions. So how do these plans stack up in real terms?

Here they go again: Republicans in Congress are reviving the ACA repeal debate. After enacting unprecedented cuts to Medicaid, they are looking for ways to eliminate federal premium tax credits that some help about 20M people afford marketplace plans.

My colleague @nicolerapfogel.bsky.social talked with CQ this week about why Republican HSA and cash account proposals are no substitute for extending the soon-to-expire PTC enhancements that more than 20 million ACA marketplace enrollees rely on to keep coverage affordable.

Marketplace Open Enrollment for 2026 - Beyond the Basics Updated November 10, 2025 1. What are premium tax credits (PTCs)? Premium tax credits, also known as PTCs, help individuals and families with low and

Making decisions about ACA marketplace coverage for 2026 is complicated, since the PTC enhancements that expire in Dec haven't yet been extended. We created a running list of FAQs to answer ?s about deadlines, automatic re-enrollment, and more. www.healthreformbeyondthebasics.org/marketplace-...

Marketplace enrollees have a lot on their minds this year, with premiums set to increase more than $1,000/year for the average person receiving PTCs, if PTC enhancements expire. Here are some other tips for navigating ACA marketplace enrollment in 2026:

People can enroll/change plans any time before the end of open enrollment in their state. To ensure they’re getting all the financial help they qualify for, people should check back in with their marketplace in Jan in case Congress has extended the PTC enhancements. www.cbpp.org/media/market...

If you are automatically reenrolled and don’t want that plan, you can cancel that enrollment any time through Dec 31 and avoid having to pay Jan premiums. (Some people will still be protected from owing these if they simply don’t pay their Jan premium, but not everyone!)

People enrolled through HealthCare.gov can opt out of automatic enrollment for 2026 by logging into their account, going to “My Plans & Programs,” and selecting the “stop coverage” button. www.healthcare.gov/keep-or-chan...

People ineligible for premium credits in 2026 – incl. certain immigrants who have income <100% FPL (who are losing coverage due to the Republican megabill) & ppl w/ income >400% FPL (if PTC enhancements expire) – should take action by Dec 15 to avoid surprises & bank overdraft fees.

If Congress hasn’t extended PTC enhancements by then, it’s very important not to rely on automatic reenrollment, since premiums will be so much higher in every state. www.cbpp.org/research/res...

Dec 15 is the last day you can update your info, make a plan selection for Jan 1 coverage, or opt out of automatic reenrollment before the marketplace automatically renews your 2025 coverage and financial help for 2026.

Make sure your marketplace insurer has your updated contact information, so you don’t miss any important updates.

Right now, you should log into your marketplace account and update your household size and income information to ensure you get the right amount of financial help in 2026. For help estimating income, see: www.healthreformbeyondthebasics.org/key-facts-in...

#OpenEnrollment for 2026 marketplace plans started Nov 1 in most states. B/c Congressional Rs haven’t extended PTC enhancements, ppl are seeing higher costs as they review their options. If you’re in need of marketplace coverage, here are some key dates to keep in mind during this uncertain time:

Check out this new paper from my colleagues @gidlukens.bsky.social and Elizabeth w/data on massive premium hikes for ACA marketplace coverage in 2026. Reminder: this is avoidable! Congress can extend the PTC enhancements and ensure millions of people can keep affordable health coverage next year.

2026 premiums are posted on HealthCare.gov. I checked out my hometown zip code in Lansing, MI. Someone w/an income less than $2,000/mo who paid $0 for a plan this year would pay $82/mo in 2026. That’s not affordable. Congress needs to act now to extend the PTC enhancements!

Rhode Island opened window shopping today for 2026 ACA marketplace plans. Because of expiring premium tax credit enhancements, a typical 60-year-old couple making $85,000 will have to pay an additional $18,600 annually for benchmark coverage. (1/4)

It's imperative that Congress take action to extend the premium tax credit enhancements for the 20 million+ ACA marketplace enrollees who rely on them. In the meantime, enrollees may have concerns. Here are some tips to help navigate this complicated time.

How would eliminating $0 Marketplace premiums affect insurance coverage? | Brookings

Nearly 1 million people with low incomes would become uninsured if marketplace enrollees lose access to $0 premium plans, as some in Congress have proposed. Coverage loss would mostly occur due to additional red tape.
From @mattafiedler@bsky.social: tinyurl.com/2wkzmexn

More dispatches from states that have posted 2026 premiums: There will be huge increases in Minnesota and Maryland if the PTC enhancements aren't extended.

Here's another state snapshot from my colleague @gidlukens.bsky.social. Nevada marketplace enrollees' premiums will skyrocket if the PTC enhancements are not extended.

Virginia’s 2026 ACA marketplace window shopping is underway, meaning people are already seeing next year’s premiums spike because of expiring tax credit enhancements. A typical 60-year-old couple making $85,000 in Virginia will face a $18,000 increase in annual premiums. (1/4)