New Regulations Issued by the Trump Administration
As we (and many others) predicted, the Trump Administration issued new proposed regulations for the ACA marketplaces on Monday. There’s lots of good commentary out there such as this summary from Joshua Brooker, that I’d encourage you to check out. But at a high level, here are some key proposals:
The 150% FPL perpetual SEP will end. I was a critic of this SEP from its proposal and I think this will likely lead to lower enrollment but less adverse selection. This may also make it easier for health plans to offer broader network offerings without fear of mid-year switchers undermining their margins
Open enrollment nationwide (including in SBMs) will be November 1 to December 15.
Lots more requirements for folks to verify their income and verify their SEP eligibility. Inevitably, this will hurt enrollment: there will be fewer folks receiving APTCs and fewer folks enrolling outside of open enrollment. The impact on the risk pool is unclear – it will be harder to commit fraud (or enroll under circumstances that don’t rise to the level of fraud, but probably aren’t within the spirit of the Marketplace framework), but the barriers to enrollment also could mean that individuals who are healthy don’t find the administrative hassle worth it.
The de minimis range for the actuarial value of plans will be expanded, allowing lower AV (i.e. higher cost sharing) plans to be offered within each metal level.
The premium adjustment percentage will be revised, which means the highest allowable individual out of pocket maximums in 2026 will be $10,600 (instead of the $10,150 set in the NBPP finalized in the last days of the Biden administration).
For individuals who have not acknowledged their continued eligibility for APTCs in the last twelve months, they will have $5 deducted from their APTC if they have a $0 net premium plan. This means passive renewals of $0 premium plans will generally go away.
Plans will once again be allowed to condition effectuation of a new policy on payment of past due premium from within the last twelve months. This will limit some gaming, but also means that if people lose their APTC, they could potentially have a massive bill to pay to get re-enrolled if they later regain APTC.
I already analyzed several of these possibilities in my prior post from a few weeks ago, so I won’t rehash that analysis. However, two areas I think are worth highlighting as plans think about their 2026 strategy.
First, it’s clear that they want to limit auto-renewal of $0 net premium plans. The large passive renewal rate seen this past OE suggests that unless plans change their tactics, they’ll see a lot of year over year attrition from folks who are currently enrolled in $0 net premium plans. Plans will need to actively engage their members who have $0 premium plans to ensure they stay enrolled, and they should start thinking now about how they can get good contact information for members and how they might incentivize members and brokers to actively renew. They should especially look at their population who are $0 premium and non-utilizers - if they’ve been non-utilizers for several years, there’s a decent chance they’ll attrition out, and they should set their membership projections accordingly.
Second, the expanded de minimis range means there will be cheaper but less generous plans available at all metal levels. This likely means APTC becomes a bit less generous, too, since the lowest and second lowest cost silver plans are likely to be plans that are at the bottom out the AV range. Additionally, with an expanded AV range, it seems likely to me that the limitation on standardized plans is not long for this world.
A revised AV calculator and the final templates for the PY2026 filings will need to be issued soon, so stay tuned for what comes next!