How the GOP megabill may roll back the Affordable [Fraud...] Care Act

https://www.axios.com/2025/05/30/gop-megabill-affordable-care-act

The massive Republican budget bill working its way through Congress has 
mostly drawn attention for its tax cuts and Medicaid changes.

But it would also take steps to significantly roll back coverage under the 
Affordable Care Act, with echoes of the 2017 repeal-replace debate.

Why it matters: The bill that passed the House before Memorial Day 
includes an overhaul of ACA marketplaces that would result in coverage 
losses for millions of Americans and savings to help cover the cost of 
extending President Trump's tax cuts.

It comes after a growth spurt that saw ACA marketplace enrollment reach 
new highs, with more than 24 million people enrolling for 2025, according 
to KFF. The House's changes would likely reverse that trend, unless the 
Senate goes in a different direction when it picks up the bill next week.

Driving the news: The changes are not as sweeping as the 2017 effort at 
repealing the law, but many of them erect barriers to enrollment that 
supporters say are aimed at fighting fraud.

Brian Blase, president of Paragon Health Institute and a health official 
in Trump's first administration, said Republicans are focusing on rolling 
back Biden-era expansions "that have led to massive fraud and 
inefficiency."

The CBO estimates the ACA marketplace-related provisions would lead to 
about 3 million more people becoming uninsured.

Cynthia Cox, a vice president at KFF, said while the changes "sound very 
technical" in nature, taken together "the implications are that it will be 
much harder for people to sign up for ACA marketplace plans."

What's inside: The bill would end automatic reenrollment in ACA plans for 
people getting subsidies, instead requiring them to proactively reenroll 
and resubmit information on their incomes for verification.

It would also prevent enrollees from provisionally receiving ACA subsidies 
in instances where extra eligibility checks are needed, which can take 
months.

If people wound up making more income than they had estimated for a given 
year, the bill removes the cap on the amount of ACA subsidies they would 
have to repay to the government.

Some legal immigrants would also be cut off from ACA subsidies, including 
people granted asylum and those in their five-year waiting period to be 
eligible for Medicaid.

What they're saying: In a letter to Congress, patient groups pointed to 
the various barriers as "unprecedented and onerous requirements to access 
health coverage" that would have "a devastating impact on people's ability 
to access and afford private insurance coverage."

The letter was signed by groups including the American Cancer Society 
Cancer Action Network, American Diabetes Association and American Lung 
Association.

Between the lines: A last-minute addition to the bill would also make a 
technical but important change that increases government payments to 
insurers in ACA marketplaces.

That would have the effect of reducing the subsidies that help people 
afford premiums and save the government money, by reducing the benchmark 
silver premiums that are used to set the subsidy amounts.

Democrats are concerned that if Congress also allows enhanced ACA 
subsidies to expire at the end of this year, the combined effect would be 
even higher premium increases for enrollees next year.

Insurers that already are planning their premium rates for next year say 
the Republican funding changes are throwing uncertainty into the mix.

"Disruption in the individual market could also result in much higher 
premiums," the trade group AHIP warned in a statement on the bill.

The big picture: Blase said changes like ending automatic reenrollment are 
needed to increase checks that ensure people are not claiming higher 
subsidies than they're entitled to.

"I think what happened during the Biden years led to massive fraud and 
improper spending, and that needs to be rolled back," he said.

Cox said another way to address fraud would be to target shady insurance 
brokers, rather than enrollees themselves. She estimated that marketplace 
enrollment could fall by roughly one third from all the changes together.

"The justification for many of these provisions is to address fraud," she 
said. "The question is, how many people who are legitimately signed up are 
going to get lost in that process?"


-- 
November 5, 2024 - Congratulations President Donald Trump.  We look 
forward to America being great again.

We live in a time where intelligent people are being silenced so that 
stupid people won't be offended.

Every day is an IQ test. Some pass, some, not so much.

Thank you for cleaning up the disasters of the 2008-2017, 2020-2024 Obama 
/ Biden / Harris fiascos, President Trump.

Under Barack Obama's leadership, the United States of America became the 
The World According To Garp.  Obama sold out heterosexuals for Hollywood 
queer liberal democrat donors.