January 30, 2026

Last Call: State-Based Enrollment

Open Enrollment wrapped up for the federal Marketplace on January 15, 2026. Some state-based marketplaces offer extended enrollment through the end of the month. Assisters and navigators in the following states should note their local extended enrollment deadlines for coverage that starts February 1st:

As of this week, efforts to extend enhanced premium tax credits (ePTCs) to resolve the ACA Marketplace affordability crisis have remained stalled. Despite some state-based supports and programs aimed at alleviating consumer costs, a comprehensive federal solution has not been reached. Additionally, Congress is poised for a partial government shutdown today, just weeks after the last shutdown ended. The House has passed a funding bill which remains halted in the Senate. A deal appeared to have been reached yesterday, but some late objections have left that deal in doubt as of the writing of this newsletter. January 30^th is the deadline for passage of a complete package of appropriations bills that would fund the government. If you missed it last week, we posted a blog with a breakdown on some of the proposals that have been made which would address the expired tax credits and the concerns we have for how that would affect people with disabilities.

While the last budget deliberations hinged on extension of the ePTCs that make healthcare access more affordable, this current shutdown is based on the ongoing appropriations through the Department of Homeland Security (DHS) which funds ICE and U.S. Customs and Border Protection (CBP). Enrollment assisters should be aware that current immigration enforcement activities have been impacting health care and hospital facilities, affecting patient healthcare access and utilization.

Health care affordability continues to be a core issue for people across the country, especially in the disability community. In a recent KFF survey, 80% of respondents indicated that their cost of living has increased in the last year, with healthcare costs indicated as the top economic concern. Advocates and researchers have been working to push for strategic healthcare reforms that might be feasible in this current political climate. Georgetown’s Center on Health Insurance Reforms (CHIR) recently convened a diverse group of stakeholders working to advance healthcare affordability. Through these deliberations, they identified some pathways forward that have just been published in this brief report. Whether through price and billing regulation, antitrust law, or transparency reforms, there is going to need to be a system of changes to ensure the needs of consumers are protected and centered in this complex marketplace.  As KFF’s Drew Altman points out in a recent commentary, a mechanism for addressing the costs related to hospitals and doctors is often left out of the affordability conversation, even though these two areas account for 52% of healthcare spending. He reminds us that the healthcare affordability conversation has been myopically focused on spending, rather than the prices themselves:

Washington, states, employers and people would not have to scramble so much to reduce their own health spending if we did more to reduce underlying health care costs, or at least tried harder. It’s well established that the main reason we spend so much more for health care compared to other nations is the high prices we pay for health services in the U.S. But the reason our spending is rising more sharply again now is about an equal mix of utilization of services and our high prices. A hodge podge of initiatives under the rubric of “value” may be having some impact on health care use collectively, even as individual initiatives have modest effects, and some have tradeoffs that warrant scrutiny, such as narrow networks. And with industry consolidation and weak market forces in health care, and regulation out of fashion politically, little is being done to address high prices. In the absence of any meaningful way to address underlying health care costs, everyone focuses on reducing spending—their own. 

Want to test your knowledge of the Affordable Care Act? Take this short interactive quiz just released from the Kaiser Family Foundation. They link to extra resources to dive deeper into who the ACA serves, and how it’s changed since passing in 2010.

Medicaid Enrollment: The Basics

Now that the ACA Marketplace enrollment season is winding down, it’s a great time to brush up on how Medicaid is a critical resource for people with disabilities. The Commonwealth Fund produced a short video primer on Medicaid essentials to get started. As the largest provider of health insurance in the country, Medicaid is an important source of health coverage for people with disabilities, especially for those who are self-employed and older adults. Medicaid provides comprehensive care and essential home- and community-based services (HCBS) for 1 in 3 people with disabilities across the country. It is the most common coverage for people who have more than one disability. In the weeks ahead, we’ll be examining Medicaid coverage in greater detail, and sharing about the policy changes underway that affect coverage for millions of people across the country.

Archives of our weekly updates are available on the NDNRC website. Follow AAHD’s other newsletters to stay current on research opportunities and policy developments supporting people with disabilities.