Healthcare Policy & Legislative

Over the last 30 days, the expiration of enhanced premium tax credits for ACA Marketplace plans has led to significant structural shifts, with one in ten enrollees now uninsured and many citing rising health care costs as a primary concern. A recent KFF follow-up survey revealed that more than half of returning enrollees report substantial increases in their health care expenses, prompting fears of further cuts to essential household spending to afford coverage, which could impact the stability of value-based care (VBC) initiatives. Moreover, CMS's proposal to permit non-network plans on ACA exchanges has drawn criticism from payers and hospitals, reflecting ongoing tensions between policy changes and the sustainability of value-based payment models in both Medicare and Medicaid contexts. These developments underscore the urgent need for strategic positioning by ACOs and other VBC stakeholders to navigate the shifting landscape effectively, especially as pressures mount on affordability and coverage continuity. For more insights on the ACA coverage changes, see KFF's coverage of rising health care costs.