Charles Gaba's blog

via Peter Sullivan & Victoria Knight of Axios:

More congressional Republicans are saying they could support a limited extension of enhanced Affordable Care Act subsidies — but only as part of a wider deal and with possible new limits to the assistance.

Why it matters: Democrats are pushing for a clean extension, but the more realistic path, if there's one at all, is a short-term extension that includes conservative health policies.

What they're saying: "How many clean extensions have you seen of late?" said Sen. Thom Tillis, who began pushing for a subsidy extension in the spring. He added that he didn't know what the contours of a deal could look like.

...Changes that could make an extension more palatable for Republicans include limiting the subsidies for higher-income enrollees or requiring that all enrollees pay at least some cost-sharing or premiums.

Originally posted 7/17/25

Now that I've finally completed overhauling & updating my House District Healthcare Enrollment Pie Chart project with the latest data, I wanted to address a rather frustrating elephant in the room.

For most of the healthcare programs involved, the enrollment data is now reasonably up to date:

• ACA Qualified Health Plan (QHP) enrollment is as of February 2025 via official Centers for Medicare & Medicaid Services (CMS) public use files.

• ACA Basic Health Plan (BHP) enrollment is as of April 2025 (NY), May 2025 (OR) or July 2025 (MN) via each state's health department monthly reports.

(with apologies to “Weird Al” Yankovic)

Last winter, I initiated an ambitious project in which I generated graphics to illustrate just how much net ACA premiums are likely to increase starting on January 1st, 2026 (slightly over 5 months from today) assuming the enhanced premium subsidies provided by the Inflation Reduction Act over the past several years are allowed to expire.

This project took several months to complete, as I had to generate both tables and bar graphs for all 50 states (+DC), using 4 different households at multiple income brackets for each. All told, that's over 1,600 different examples.

I made sure to include various caveats for these projections. For instance, each of these examples assumes...

Hoo boy. Via the Delaware Insurance Dept:

Plan year 2026 health and dental insurance rate filings, as proposed, are available for the companies listed below. These filings are subject to actuarial review. Additional companies will be listed as their filings are received. Any insurance filings already approved are available to the public through the NAIC’s System for Electronic Rate and Form Filing (SERFF) interface. There is no fee for using SERFF. Rate info can also be accessed at the Rate Review  page at Healthcare.gov

AmeriHealth Caritas VIP Next, Inc:

• Company Legal Name AmeriHealth Caritas VIP Next, Inc.
• Market for which proposed rates apply (Individual or Small Group) Individual
• Total proposed rate change (increase/decrease) 46.20% increase
• Effective date of proposed rate change January 1, 2026

Summary

The Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

April 2025 Key Findings - Medicaid and CHIP Enrollment

• In April 2025, 78.4 million individuals were enrolled in Medicaid and CHIP.
• 71.1 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
• 41.1 million adults were enrolled in Medicaid, and there were 37.3 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

I joined my friend Laura Packard of CareTalk earlier today to discuss the upcoming IRA subsidy expiration iceberg which the ACA Titanic is about to hit just 5 months from today.

(if you tune in while the show is still airing live you'll have to scroll back to the beginning to see my segment)

Me, on April 22nd:

So, all of that was last summer. Skip ahead ten months and voila, the U.S. Supreme Court did indeed hear arguments in the case yesterday...and while the headline from the AP makes it sound positive, there's a potentially very dark lining as well:

 The Supreme Court seemed likely to uphold a key preventive-care provision of the Affordable Care Act in a case heard Monday.

Conservative justices Brett Kavanaugh and Amy Coney Barrett, along with the court’s three liberals, appeared skeptical of arguments that Obamacare’s process for deciding which services must be fully covered by private insurance is unconstitutional.

It's a little awkward to try & pull quotes from Georgia's actuarial memos because they're heavily redacted (see attachments below), but fortunately I also have access to other "just the facts" filing documents which include the hard data I need to compile my weighted averages. These forms--officially called "Rate Filing Transmittal Form LH-T1" and "Unified Rate Review" forms--include, among lots of other numbers, the preliminary avg. rate change being requested for the carrier's individual (or small group) market plans, as well as the number of current effectuated enrollees they have.

In addition, I have alternate rate filings for Georgia individual market carriers which specifically state what their requested rate changes would be if the enhanced premium tax credit subsidies provided by the American Rescue Plan Act & Inflation Reduction Act were to be extended for at least one more year, providing a clear apples to apples comparison.

Neighborhood Health Plan of Rhode Island (if IRA subsidies are extended):

Weighted Average Rate Increase: This represents the average rate increase, including modifications to prior year benefits and other pricing adjustments. The average premium increase to consumers, before reflecting changes in age is expected to be 16.3%.

The range of rate changes, before reflecting changes in age, which consumers will experience, is approximately 15.0% to 17.5%.

Neighborhood Health Plan of Rhode Island (if IRA subsidies AREN'T extended):

Weighted Average Rate Increase: This represents the average rate increase, including modifications to prior year benefits and other pricing adjustments. The average premium increase to consumers, before reflecting changes in age is expected to be 21.2%.

The range of rate changes, before reflecting changes in age, which consumers will experience, is approximately 20.1% to 22.2%.

Blue Cross Blue Shield of RI (if IRA subsidies are extended):

via the Indiana Dept. of Insurance:

Rate Watch is a convenient way for Hoosiers to access key data on Accident and Health rate filings submitted to the IDOI on or after May 1, 2010. Use it to determine which companies have requested rate changes, their originally requested overall % rate change, and the overall final % rate change approved. These are overall rate changes and are not individually specific. The table below is searchable and sortable. You can also download your filtered results by pressing the Save Excel File button at the bottom of the table. If you need the full data set, including a few additional columns, you can download the CSV file.

...INDIANA 2026 ACA FILINGS

The overall requested average rate increase for 2026 Indiana individual Marketplace plans is 20.5%. This year's requested rate increases were substantially impacted by the assumptions that for 2026 Congress will not continue enhanced premium subsidies available to Hoosiers under the American Rescue Plan Act and the Inflation Reduction Act and that Congress will fund Cost Sharing Reductions.