Democrats are subtly dismantling the Affordable Care Act. Here's the breakdown
In a dramatic shift, recent changes to the Affordable Care Act (ACA) under the "One Big Beautiful Bill" (OBBBA), signed into law on July 4, 2025, and new rules from the Centers for Medicare and Medicaid Services (CMS) are causing substantial impacts on health coverage, premiums, and enrollment.
Key Changes
The OBBBA introduces steep cuts to Medicaid, totalling approximately $739 billion over 10 years. These cuts are achieved through new eligibility requirements, increased frequency of eligibility verification, and work or community engagement mandates for recipients. These changes are expected to reduce Medicaid enrollment, particularly among young adults and lawfully present immigrants, and limit states' ability to use provider taxes to supplement funding [1][3][5].
Another significant change is the expiration of enhanced premium tax credits that helped ACA marketplace enrollees afford coverage, scheduled for the end of 2025. This move is estimated to cause an additional 5 million people to lose insurance coverage as financial assistance ends [3].
New ACA Marketplace rules, such as the ACA Marketplace Integrity and Affordability rule from CMS, aim to maintain plan integrity and affordability but also contribute to insurer premium increases [2]. As a result, premiums in the ACA marketplace are expected to rise sharply in 2026, with a median proposed increase around 18%. Without tax credits, out-of-pocket premiums could increase by over 75% [2].
Expected Impacts
The changes are expected to lead to increased numbers of uninsured Americans. The Congressional Budget Office projects about 10.9 million more uninsured people due to Medicaid cuts. Another estimated 5 million could lose ACA marketplace coverage with the loss of subsidies [1][3].
Additional pressure is expected on safety-net providers and health systems, especially in Medicaid expansion states, as funding cuts and reduced provider tax benefits may slash millions in annual Medicaid funding, threatening their financial stability [1].
The rise in premiums and reduced affordability in the ACA marketplace will likely cause lower enrollment among healthier individuals, worsening the risk pool and potentially leading to further premium increases, creating a challenging environment for marketplace plans [2].
Work and eligibility requirements for Medicaid have been associated with increased bureaucratic burdens and coverage losses, particularly harming vulnerable populations like young adults [3][5].
In summary, these recent policy changes under the OBBBA and CMS rules are expected to sharply reduce Medicaid and ACA marketplace coverage, increase premiums, and place additional strain on healthcare providers serving low-income populations.
Sources: [1] Center on Budget and Policy Priorities [2] KFF [3] Congressional Budget Office [4] The Hill [5] Kaiser Family Foundation
Read also:
- Guidelines for Fortifying No-Code Apps in Regulated Sectors
- UK-based software, MEMORI, earns distinction as the nation's first certified software-as-a-medical device, offering real-time infection prediction capabilities.
- Day Care Center Employees' Daily Responsibilities Explored
- The Science behind the molding of Human Essence by the Brain: Unveiling the Mysteries of What Makes Us, Us
