Congress: The House of Representatives went on recess early this week. Without the House in session, it will be difficult for legislation to move. The implication of this is that it is very unlikely that legislation that extends enhanced subsidies (ePTC) in the individual market will be passed in time to affect 2026 rates. It also increases the likelihood that a temporary budget bill will occur. This would mean that there would be no legislative vehicle for health care related items (doc fix, sequestration, ePTCs, CSRs, etc.) until closer to the end of the year rather than at the end of September.
CMS: CMS announced last week that it would no longer be accepting 1115 waivers that provide continuous eligibility provisions for children and adults. 12 states have continuous eligibility waivers. Ending of the waivers could increase churn in the affected states.
In the Courts: 20 states sued HHS over the implementation of the program integrity rule.The states were seeking immediate injunction for at least parts of the bill, which could affect pricing in the 2026 individual market.
ACA Rates: KFF released its summary of 2026 proposed ACA rates. Overall KFF found that the median rate increase of the states it examined was around 15% or the highest increase in the past 5 years. More than a quarter of insurers are proposing rate increases of more than 20%. KFF found that the ending of the EPTCs was increasing premiums by around 4%
