The 2025 budget reconciliation is expected to have significant implications for the Affordable Care Act (ACA), Medicaid, and the uninsured rate in the United States. Several key provisions are anticipated to be included in the reconciliation, which may lead to changes in healthcare coverage and accessibility.Firstly, regarding the ACA, potential modifications could impact the health insurance marketplaces, including subsidies for individuals and families purchasing coverage. The reconciliation might extend or make permanent the enhanced subsidies provided under the American Rescue Plan Act, which could help maintain or increase the number of individuals covered under the ACA. This, in turn, could stabilize or even expand the health insurance marketplaces, potentially enhancing the overall stability of the ACA.Secondly, the budget reconciliation may also affect Medicaid, a joint federal-state program that provides health coverage to low-income individuals and families. Provisions could include incentives for the 12 states that have not expanded Medicaid under the ACA to do so, potentially covering hundreds of thousands of additional individuals. Other potential changes could involve adjustments to Medicaid eligibility, benefits, or reimbursement rates, which could either expand coverage or alter the scope of services provided to Medicaid beneficiaries.Lastly, the changes to the ACA and Medicaid through the 2025 budget reconciliation are likely to impact the uninsured rate in the U.S. If the reconciliation leads to more generous subsidies, incentives for Medicaid expansion, and other provisions that make healthcare more affordable and accessible, it could result in a decrease in the uninsured rate. Conversely, if changes lead to less affordable or less comprehensive coverage options, the uninsured rate might increase. The ultimate effect will depend on the specific provisions included in the reconciliation and how they are implemented by states and the federal government.Overall, the 2025 budget reconciliation has the potential to significantly influence the landscape of healthcare coverage in the United States, with implications for the ACA, Medicaid, and the number of uninsured individuals. The exact nature of these changes will be determined by the final provisions included in the reconciliation package.

by | May 17, 2025 | Care, Insurance

Congressional Republicans are considering a budget reconciliation package that would significantly alter Medicaid and the Affordable Care Act (ACA). The proposed changes include work and reporting requirements for certain Medicaid enrollees, codifying changes to the ACA Marketplaces, and allowing states to impose new cost-sharing requirements. These changes are estimated to increase the number of uninsured people by at least 13.7 million by 2034, according to the Congressional Budget Office (CBO).

The Medicaid provisions in the proposal would reduce enrollment by at least 7.7 million people, primarily due to new work and reporting requirements, stricter eligibility renewal processes, and lower federal matching rates for states that cover immigrants. Additionally, the proposal would delay streamlined eligibility and enrollment processes, impose new verification requirements, and reduce retroactive coverage.

The codification of the ACA Marketplace Integrity and Affordability Proposed Rule would also lead to an estimated 1.8 million more uninsured people by 2034. This rule would shorten the open enrollment period, restrict special enrollment periods, and impose new documentation requirements for income verification.

Furthermore, the expiration of enhanced premium tax credits, which are set to expire at the end of 2025, would lead to an estimated 4.2 million more uninsured people. These tax credits have reduced premium payments by an average of $705 per year and have led to a significant increase in ACA Marketplace enrollment. Without these credits, enrollees’ out-of-pocket premium payments would increase by over 75% on average, with lower-income and older enrollees being disproportionately affected.

Overall, the proposed changes would lead to a significant increase in the uninsured rate, reversing years of progress in reducing the number of uninsured Americans. The CBO estimates that the uninsured rate would increase by about 30% if these changes go into effect. The proposed changes would also have a disproportionate impact on vulnerable populations, including low-income individuals, older adults, and people with disabilities.