Recent discussions in Washington, D.C., have shifted from efforts to dismantle the Affordable Care Act (ACA) to focusing on the future of its premium subsidies, which are scheduled to end in 2025, as reported by The Washington Post on September 12.
During a debate on September 10, former President Donald Trump was asked whether he still planned to replace the ACA and, if so, what that replacement would entail. Trump responded by mentioning that he had "concepts of a plan" but emphasized that any changes would only occur if a better and more affordable option emerged. He suggested that more details would be shared in the near future.
The GOP, which spent years calling for the repeal of the ACA, has pivoted away from that stance in recent years. The healthcare law gained prominence again when Trump made it a central issue in his 2024 campaign, promising to replace it if he wins re-election.
The ACA marketplace, which allows individuals to purchase insurance through exchanges, has seen rapid growth, with over 20 million people enrolling for 2024—setting a new record. This surge in enrollment has been driven in part by federal subsidies that assist low-income individuals in affording coverage. These subsidies, however, will expire at the end of 2025 unless renewed.
According to the Congressional Budget Office (CBO), extending these subsidies could add an estimated $335 billion to the federal deficit between 2025 and 2034. If these subsidies are not renewed, it’s expected that fewer people will sign up for coverage.
Despite the significance of these subsidies, it’s unlikely that they will play a major role in the upcoming presidential election. The complexity of the issue makes it difficult for candidates to address fully in their campaigns.
In addition to concerns over the future of subsidies, Republican lawmakers have raised alarms about potential fraud on the ACA exchanges. They contend that third-party platforms make it easier for unauthorized brokers to alter the plans of enrollees without their consent. The Centers for Medicare & Medicaid Services (CMS) reported that it received 40,000 complaints about unauthorized changes in the first quarter of 2024, with nearly all of these cases resolved.
To address these concerns, CMS implemented new rules in July, requiring that agents and brokers can no longer make changes to an individual’s enrollment unless they are already associated with that plan. New or unassociated brokers must now facilitate a three-way call with the consumer and a CMS representative or instruct the consumer to make changes themselves.