Tax Credit Proposals Stall as OE2026 Ends
Despite passage of a House bill to extend enhanced premium tax credits (ePTCs) last week, no action has been taken in the Senate to move this proposal forward. Enhanced premium tax credits are an essential mechanism for making ACA coverage affordable that appears to have stalled in Congress. This has now been complicated by the proposal released by the Trump administration this week. AAHD is still reviewing current proposals, but has concerns over the direction that the administration’s proposal would take.
The Center on Budget and Policy Priorities (CBPP) addresses some of the current messaging being used to undermine ePTC passage, and argues that they are still a critical way to stabilize the insurance pool and overall costs to consumers through a broader trend of rising healthcare costs. While there may be isolated incidents of fraud from certain predatory insurance brokers, CBPP calls for targeted action against bad actors rather than reducing the supports for consumers who need it, and that the various factors that are making health costs rise must be addressed at the roots, rather than undermining access for consumers. CBPP analysis points out that current policy developments are not addressing, but rather inflaming, this affordability crisis, particularly related to public health. These impacts are affecting a large cross-section of America, including people with disabilities.
Total Marketplace enrollment is down from last year by over 800K people, according to a report from the Centers for Medicare and Medicaid Services, with fewer people enrolling on the Healthcare.gov platform than state-based exchanges. Accurate enrollment data won’t be available until the summer. About 2 in 5 sign-ups were automatic enrollments, meaning that there may still be consumers who ultimately choose to disenroll or forego payment when they see the cost without their enhanced premium tax credit applied.
Special Enrollment Periods
Beyond Open Enrollment, there are Special Enrollment Periods (SEPs) throughout the year that allow individuals to enroll in ACA Marketplace coverage in response to specified life changes. Be sure to share these options with potential enrollees to anticipate upcoming qualifying events. These include:
- Household Changes like getting married, having or adopting a child, divorce, separation, or loss of a household member.
- Residence Changes when a person relocates to a new home, changing county or zip code. People who move for school, seasonal work, shelter, or transitional housing are also able to enroll.
- Losing Health Coverage whether employer-sponsored insurance, Medicaid/CHIP, or individual coverage through a Marketplace or student plan.
- Transition Periods, like leaving incarceration, ending service through an AmeriCorps or National Civilian Community Corps (NCCC) program, or leaving an abusive relationship.
- Status Changes like gaining membership in a federally recognized tribe or becoming a U.S. citizen.
- Unexpected Circumstances like a serious medical condition, natural disaster, or recognized emergency that interfered with your ability to enroll during Open Enrollment.
This is not a comprehensive list of all the SEPs that are available. It’s important to note that the Low-Income SEP is no longer available, which had allowed enrollees living below 150% of the federal poverty line to enroll in coverage.
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