NASHP: 16M would become uninsured due to #OneBigUglyBill + loss of IRA tax credits; 8.2M in marketplaces alone

16 Million Americans Would Become Uninsured Due to Reconciliation Bill and Loss of Tax Credits; 8.2 Million in Marketplaces Alone

Leaders from State-based Health Insurance Marketplaces, Enrollees, Providers, and Small Business Highlight Potential, Devastating Impacts

(Washington, DC) The Congressional Reconciliation bill and loss of federal tax credits would result in 16 million Americans losing health coverage, including 8.2 million enrolled in Health Insurance Marketplaces. By stripping millions of lives from the Marketplaces, health care will be more expensive, harder to access, create a strain on health care systems, and hurt small businesses.

At a virtual press conference earlier today, leaders from across the country detailed the impacts on access to private health insurance from the Reconciliation bill passed last month by the House of Representatives. Combined with the looming expiration of federal tax credits at the end of the year, these changes would sharply increase the uninsured rate, deeply damage health care delivery, and increase costs in every community across America.

Today, a record 24 million Americans get their private health insurance through the Marketplaces, and an estimated one in seven Americans have depended on the Marketplaces for coverage at some point during the 12 years since the Affordable Care Act (ACA) was enacted.

“The proposed changes in this bill, coupled with the expiration of the enhanced federal subsidies, would leave millions of Americans uninsured and vulnerable – facing worse health outcomes and the risk of financial disaster with just one medical emergency,” Covered California executive director Jessica Altman said. “A truly beautiful bill would seek to provide health care coverage to more Americans, not strip it away from millions and make it less affordable for millions more.”

“The proposed reconciliation bill doesn’t just make coverage more expensive—it makes it harder to get. Marketplace enrollees could face large increases in premiums and new red tape that makes it a burden to get the coverage they need,” said Devon Trolley, Executive Director of Pennie, Pennsylvania’s Health Insurance Marketplace. “This combination is a one-two punch that puts millions at risk of going uninsured—not because they don’t qualify, but because they can’t afford it or can’t navigate the new bureaucracy.”

“ACA coverage is a lifeline for Maryland’s rural and underserved communities. Rolling it back would risk the health and well-being of those who need care the most,” said Jonathan Dayton, Executive Director, Maryland Rural Health Association.

The loss of coverage for 8.2 million people in Marketplace plans is more than half of the 16 million that would lose coverage under the Reconciliation Bill, as estimated by the Congressional Budget Office. Others would lose coverage under Medicaid, and, importantly, Marketplaces would no longer be available as a coverage option for them, tightening affordable options for those who most need help affording plans.

Analyses from Health Insurance Marketplaces indicate that the bill could have significant cost impacts for their enrollees.  Preliminary analysis from Rhode Island indicates $61.4 million in lost tax credits for its consumers, a 43% reduction of current funds. Pennsylvania predicts nearly $1.2 billion in tax credit losses, dollars that support consumers and the state’s health care system.

The Affordable Care Act established Health Insurance Marketplaces, which allow individuals to purchase subsidized health insurance plans that meet specific coverage standards. The Marketplaces enable consumers to view and shop for a variety of plans, all of which are required to cover essential health benefits and must also prohibit discrimination.  Twenty-two states operate marketplaces, either as fully state-run entities or in partnership with the federal Marketplace.

The Marketplaces also protect consumers from discrimination and attempts to limit their coverage while offering tax credits to make health insurance more affordable for eligible individuals.

View Federal Resources about the Reconciliation bill, including State Marketplace Network letters to congress and detailed explainers about the bill here.

A recording of the press conference is available upon request.

The link above also includes a detailed, section-by-section explainer of how every provision of the GOP's #OneBigUglyBill would negatively impact ACA exchange enrollment:

• Takes away consumers’ ability to automatically renew their private health insurance coverage, and prohibits premium tax credits while applicants submit follow-up paperwork to enroll in a health plan (Section 112201)

• Increases tax repayment for consumers and exposes lower income taxpayers to significant tax credit repayment (Section 112203)

• Modifies the formula for determining an individual or family’s premiums and cost-sharing in a way likely to raise consumer costs (Section 44201(d))

• Allows the Secretary of Health and Human Services to arbitrarily withhold tax credits for mid-year enrollees (Section 112202)

• Allows insurers to reduce the value of their plans (Section 44201(c))

• Causes market disruption and increases consumer premiums by funding cost-sharing reductions starting in 2026, after issuers have already developed their rates

• Forces states to shorten their Open Enrollment Periods (Section 44201(a))

• Forces states to give up local control over Special Enrollment Periods (Section 44201(a))

• Eliminates premium tax credits for Marketplace enrollees below the poverty line (Section 112102)

• Eliminates tax credits for most lawfully present non-citizens (Section 112101-112102)

• Excludes recipients of Deferred Action on Childhood Arrival from the Marketplaces (Section 44201(i))

• Eliminates consumer protections and tax credits for certain gender-related medical care (Section 44201(h))