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Future of the Individual Market: Impact of the House Reconciliation Bill and Other Changes on the ACA Individual Market

In this new Wakely report, we analyze the effects of both the House budget reconciliation bill and the expiration of enhanced premium tax credits (ePTCs). The report highlights that the individual market will look fundamentally different when the full effects of all proposed changes occur. Specifically, the combination of ePTC expiring and full enactment of ... Read more

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The Future of the ACA Individual Market: Policy Shifts and the House Reconciliation Bill

Join us for an in-depth discussion on the future of the individual market and the impacts of potential Congressional and regulatory changes to the Affordable Care Act (ACA). This webinar will explore findings from a new Wakely report which estimates that ACA enrollment could decrease by 11 to 13 million as a result of these pending changes, representing a 47% to 57% decline. The report also projects that market average premiums could increase between 7% and 11.5% on top of claims trend. The report’s analysis considers a range of influential factors, including provisions in the House budget reconciliation bill, the Marketplace Integrity and Affordability regulation, and the scheduled expiration of enhanced premium tax credits in 2026. Experts will unpack how these shifts may reshape coverage, affordability, and the long-term viability of the individual market.

Whether you’re a policymaker, plan administrator, or healthcare advocate, this session will equip you with critical insights to prepare for the market ahead.

Learn more and register

Newsworthy Findings

CDC Panel, Newly Remade by RFK Jr., Questions Vaccine Evidence

New members of the ACIP panel raised questions about the evidence supporting COVID vaccines, and signaled plans to look at other established shots.

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Editor's Note
In mid-June, RFK Jr. replaced all 17 members of the Advisory Committee on Immunization Practices (ACIP), who were respected experts in epidemiology and infectious disease, appointing eight new members in their place. The panel is scheduled to vote on recommendations for vaccines against RSV, influenza, and chikungunya.

Health Insurers, Nudged by Trump Administration, Pledge Reform to Prior Authorization

Major health insurers have agreed to six new commitments that should make accessing care easier for patients while removing administrative burden on providers.

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Editor's Note
The pledges include scaling back some prior authorization requirements, honoring approvals when members switch health plans, and improving transparency around appeals for denied care. Dr. Oz stated that federal officials will monitor insurer compliance and are prepared to consider regulations if these standards aren't met. However, hospitals and physicians remain skeptical, noting similar voluntary agreements made in 2018 failed to produce lasting change.

Medicaid, SNAP Cuts Could Lead to Nearly 500,000 Lost Healthcare Jobs: Report

Across the country, 1.2 million jobs could be lost in 2029 as funding reductions to the safety-net insurance and the Supplemental Nutrition Assistance Program, or SNAP, ripple through states. The impact would be comparable to increasing the nation’s unemployment rate by one-sixth.

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Editor's Note
The One Big Beautiful Bill Act includes several healthcare provisions including significant cuts to Medicaid Health Cuts to Medicaid and SNAP which would lower states’ gross domestic products by $154 billion in 2029, 18% higher than the savings the bill would provide to the federal government.

Medicare Go-Broke Date Pushed Up Three Years in Latest Trustees Report

A key trust fund underpinning Medicare’s hospital benefit will go broke three years earlier than previously expected absent congressional action, threatening benefits for seniors. The Medicare Hospital Insurance trust fund will be depleted in 2033, instead of 2036, as Medicare spending continues to outpace the program’s income.

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Editor's Note
The bleaker outlook is due to higher-than-expected spending for hospital care, hospice services and physician-administered drugs. The trustees called on Congress to act quickly to stabilize Medicare, though near-term action is unlikely as the Republican majority focuses on advancing their reconciliation megabill.

Oz Hints at Impending CMS Rule to Force Drug Price Transparency

The Trump administration hopes to issue a rule this year empowering regulators to “very forcefully” go after companies that don’t share information on drug costs, the CMS administrator said.

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Editor's Note
In May of this year, the Trump administration issued a request for information on prescription drug price transparency, believing that when prices are more transparent, patients can compare prices and eventually push prices down across the board. Now, the administrator of CMS, Dr. Mehmet Oz, says there are plans to create rules to force insurers and their pharmacy benefit managers to disclose the prices of drugs.

Bonus Article

Just for Fun

Math Joke:

Why did the p-value break up with the null hypothesis?

Prior Week

Q: Why did the girl wear glasses during math class?

A: It improved di-vision

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