October 3, 2025

Enrollment in ACA exchanges has surged since enhanced subsidies were introduced, with most participants receiving tax credits. Premiums are also being driven higher by changes in how those credits are calculated. For example, KFF notes a 60-year-old couple with an income of $85,000 could face premium increases of over $22,600, while a 45-year-old earning $20,000 would see monthly costs rise from $0 to $420.

The shutdown that began Wednesday was fueled in part by disputes over ACA subsidies. According to HHS’ contingency plan, nearly half of CMS employees are on furlough, and deeper cuts may follow if the standoff drags on. While many federal health workers are sidelined, mandatory programs—including Medicare, Medicaid, and CHIP—remain unaffected.

Major insurers are reshaping their Medicare Advantage offerings for 2026 amid financial pressures, with CMS projecting a slight enrollment decline and payers emphasizing lower premiums, preventive care, and targeted benefits.

As consolidation accelerates in healthcare, policymakers face mounting pressure to strengthen oversight and ensure medical loss ratio rules truly protect patients and taxpayers.

Both Republicans and Democrats had proposed spending packages that would have preserved the telehealth policies through Nov. 21 and Oct. 31, respectively, though the bills didn’t gain traction. Additionally, CMS said that providers could choose to hold on submitting telehealth claims in the absence of congressional action.