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https://www.axios.com/2025/05/30/gop-megabill-affordable-care-act

The massive Republican budget bill working its way through Congress has
mostly drawn attention for its tax cuts and Medicaid changes.

But it would also take steps to significantly roll back coverage under the Affordable Care Act, with echoes of the 2017 repeal-replace debate.

Why it matters: The bill that passed the House before Memorial Day
includes an overhaul of ACA marketplaces that would result in coverage
losses for millions of Americans and savings to help cover the cost of extending President Trump's tax cuts.

It comes after a growth spurt that saw ACA marketplace enrollment reach
new highs, with more than 24 million people enrolling for 2025, according
to KFF. The House's changes would likely reverse that trend, unless the
Senate goes in a different direction when it picks up the bill next week.

Driving the news: The changes are not as sweeping as the 2017 effort at repealing the law, but many of them erect barriers to enrollment that supporters say are aimed at fighting fraud.

Brian Blase, president of Paragon Health Institute and a health official
in Trump's first administration, said Republicans are focusing on rolling
back Biden-era expansions "that have led to massive fraud and
inefficiency."

The CBO estimates the ACA marketplace-related provisions would lead to
about 3 million more people becoming uninsured.

Cynthia Cox, a vice president at KFF, said while the changes "sound very technical" in nature, taken together "the implications are that it will be
much harder for people to sign up for ACA marketplace plans."

What's inside: The bill would end automatic reenrollment in ACA plans for people getting subsidies, instead requiring them to proactively reenroll
and resubmit information on their incomes for verification.

It would also prevent enrollees from provisionally receiving ACA subsidies
in instances where extra eligibility checks are needed, which can take
months.

If people wound up making more income than they had estimated for a given
year, the bill removes the cap on the amount of ACA subsidies they would
have to repay to the government.

Some legal immigrants would also be cut off from ACA subsidies, including people granted asylum and those in their five-year waiting period to be eligible for Medicaid.

What they're saying: In a letter to Congress, patient groups pointed to
the various barriers as "unprecedented and onerous requirements to access health coverage" that would have "a devastating impact on people's ability
to access and afford private insurance coverage."

The letter was signed by groups including the American Cancer Society
Cancer Action Network, American Diabetes Association and American Lung Association.

Between the lines: A last-minute addition to the bill would also make a technical but important change that increases government payments to
insurers in ACA marketplaces.

That would have the effect of reducing the subsidies that help people
afford premiums and save the government money, by reducing the benchmark
silver premiums that are used to set the subsidy amounts.

Democrats are concerned that if Congress also allows enhanced ACA
subsidies to expire at the end of this year, the combined effect would be
even higher premium increases for enrollees next year.

Insurers that already are planning their premium rates for next year say
the Republican funding changes are throwing uncertainty into the mix.

"Disruption in the individual market could also result in much higher premiums," the trade group AHIP warned in a statement on the bill.

The big picture: Blase said changes like ending automatic reenrollment are needed to increase checks that ensure people are not claiming higher
subsidies than they're entitled to.

"I think what happened during the Biden years led to massive fraud and
improper spending, and that needs to be rolled back," he said.

Cox said another way to address fraud would be to target shady insurance brokers, rather than enrollees themselves. She estimated that marketplace enrollment could fall by roughly one third from all the changes together.

"The justification for many of these provisions is to address fraud," she
said. "The question is, how many people who are legitimately signed up are going to get lost in that process?"


--
November 5, 2024 - Congratulations President Donald Trump. We look
forward to America being great again.

We live in a time where intelligent people are being silenced so that
stupid people won't be offended.

Every day is an IQ test. Some pass, some, not so much.

Thank you for cleaning up the disasters of the 2008-2017, 2020-2024 Obama
/ Biden / Harris fiascos, President Trump.

Under Barack Obama's leadership, the United States of America became the
The World According To Garp. Obama sold out heterosexuals for Hollywood
queer liberal democrat donors.

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