Gideon Lukens

The Cassidy-Crapo proposal allows PTC enhancements to expire while pushing ppl into skimpier plans with higher deductibles...hard to see how this is a solution to the problem at hand.

HHS just released data covering the first month of ACA marketplace enrollment for 2026. My colleague @jenniferlsullivan.bsky.social puts the numbers in context:

How to Evaluate Proposals to Address Expiring Premium Tax Credit Enhancements With just weeks to go until the premium tax credit (PTC) enhancements expire — which would increase Affordable Care Act (ACA) marketplace enrollees’ annual premiums by more than $1,000 on average...

Proposals to address expiring PTC enhancements should be evaluated based on the extent to which they:

1. avoid making more people uninsured;

2. ensure people keep access to affordable, comprehensive coverage; and

3. can take effect quickly.

More here: www.cbpp.org/blog/how-to-...

Instead of a clean extension of PTC enhancements (which makes silver plans more affordable), some Republicans have proposed encouraging people to buy down to less generous bronze plans.

Don’t be fooled: While bronze plans often have lower premiums, people face much higher costs when they get care.

#ACA marketplace enrollees are real people – not phantoms. Policymakers should not let false arguments get in the way of extending the premium tax credit enhancements to prevent people’s premiums from spiking and allow them to stay covered.

While insurance broker fraud is real, the federal government has already taken steps to curtail bad actors. Targeted solutions protect people from improper conduct without raising their premiums or causing them to lose coverage. tinyurl.com/2zzfx5yv

Health Insurance Premium Spikes Imminent as Tax Credit Enhancements Set to Expire If Congress waits until the end of the year to extend the enhancements, 1.5 million more people will be uninsured in 2026 compared to an earlier extension.

And allowing premium tax credit enhancements to expire would raise premium costs for over 20 million people and cause 3.8 million to become uninsured. tinyurl.com/zndd97k7

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

Disallowing marketplace plans from offering $0 premium options or requiring people to make minimum premium payments could cause roughly a million people to lose marketplace coverage due to additional red tape, researchers estimate. tinyurl.com/2wkzmexn

And the ACA includes a backstop: if insurers take in too much in premiums compared to what they pay out for health care services, the money has to go back to consumers.

More enrollees without claims also doesn’t mean more money for insurance companies: if enrollment goes up but there are no additional claims, the cost per enrollee goes down. That means the premium per enrollee – and the federal cost per enrollee – also goes down.

The prevalence of enrollees without claims increased in recent years, but that’s because enhancements to premium tax credits pulled in people who use less medical care – because they’re enrolled for shorter periods & because they’re younger and healthier. tinyurl.com/5t2kd9y4

The existence of ppl w/out claims is a normal feature of all health & other insurance markets– not evidence of fraud, & certainly not evidence that enrollees are “phantoms.” Ppl can’t always predict when they’ll need to use their insurance, but it’s meant to be there when they do.

People With Low Incomes May Lose $0 Premium Plans — a Lifeline — Unless Congress Acts Without congressional action, PTC enhancements will expire at the end of 2025. This will cause millions —many of these lowest-income enrollees especially — to become uninsured, or to face impossible c...

ACA marketplace plans w/ $0 premiums help ppl get & stay covered. Recent Republican proposals would require minimum premiums or fail to extend premium tax credit enhancements based on the false claim that ppl who don’t use medical care are “phantom enrollees.” 🧵https://tinyurl.com/4uc68zbf

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.🧵

The GAO released a report last week on health savings accounts (HSAs) reaffirming that HSAs do little to help people with low and moderate incomes – who would be hurt the most if Congress lets premium tax credit enhancements expire.

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.

Marketplace Enrollees Across the Country Face Steep Premium Increases Unless Tax Credit Enhancements Are Extended Annual premium increase, 60-year-old couple with income of $85,000 (401% FPL), by congressional district, 119th Congress Note: FPL = federal poverty level. Examples are based on 2026 average...

We now have congressional district level estimates showing rising out-of-pocket premiums due to expiring premium tax credit enhancements. A 60-yr-old couple making $85k would pay $6.7k to $50k more annually. Explore our interactive map w/ downloadable data: tinyurl.com/5e826bvp

The context is that HSAs are currently being touted by some as an alternative to extending the premium tax credit enhancements.

HSAs are projected to cost $181B over 10 yrs. That amount would cover - and be better spent - extending the enhanced premium tax credits for ~6 yrs or closing the Medicaid coverage gap for ~9 years. Govt resources are limited, and HSAs have very little bang for the buck in improving affordability.

A better way would be to extend ACA marketplace premium tax credit enhancements. See table 2 for estimates for every state: www.cbpp.org/research/hea...

Expanding Health Savings Accounts Would Do Little to Improve Access to Affordable Health Care Amid the urgent debate over whether Congress will act to prevent cost increases for millions of people in 2026 marketplace plans, some Republicans are promoting expansions of health savings accounts.....

HSAs are tax shelters masquerading as health policy. They don't help people who are struggling to afford health coverage.

Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx

#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:

Open enrollment for #ACA marketplace plans has begun, and without congressional action to extend premium tax credit enhancements, millions are facing steep premium increases for 2026.

We now have downloadable graphics like this one for all 50 states plus DC, showing how expiring premium tax credit enhancements are leading to dramatic out-of-pocket premium increases. Find your state here: tinyurl.com/5x89ds7x

How concerned are people about rising health insurance premiums? With premium tax credit enhancements about to expire and ACA marketplace open enrollment underway, search volumes for terms like “health premium increase” are (almost) off the charts.

Wyoming, West Virginia, and Alaska are the states with the largest $$ increases in out-of-pocket premiums for people with moderate incomes who will lose premium tax credits entirely if the enhancements expire.

Window shopping for 2026 ACA marketplace plans is open for almost all states, and open enrollment is only days away. Millions of marketplace enrollees are seeing 2026 premiums spike due to expiring premium tax credits. See our paper with state-level estimates: tinyurl.com/zndd97k7

9/16/25 ☀️ AM: PRESENTED BY IN THIS EDITION Johnson’s tall tasks going into todaySenate may skip the NDAA againThe Vault: Why Dems want Obamacare deal nowJeffries silent

This is NOT an end-of-year issue. Open enrollment runs Nov.1 – Jan.15 for most states and window shopping begins in October. If Congress waits until Dec.31, 1.5 million more people will be uninsured in 2026 compared to an earlier extension. (4/4)
tinyurl.com/mr2bhszc

These are real people facing real consequences if Congress doesn’t act to extend the enhancements ASAP. Tracy, a customer service representative, is facing premium increases of $103 a month, which would force her to cut back on other essentials like gas and groceries. (3/4)