Policy & Regulatory Changes

The Trump administration’s ACA market rule is shifting exchange coverage toward lower-premium but higher-exposure benefit designs, including plans with up to 30% higher out-of-pocket costs and options without fixed provider networks—raising affordability and care-continuity risks for providers managing population health and downside-risk contracts (KFF Health News). At the same time, the lapse of enhanced ACA subsidies is already pushing some families to drop coverage, increasing the likelihood of uninsured churn, delayed care, and uncompensated utilization that can undermine ACO attribution stability, Medicaid redetermination planning, and payer-provider VBC performance assumptions (KFF Health News). A federal judge’s partial block of an ACA enrollment/eligibility rule and CMS’s tougher oversight of accrediting organizations add more regulatory uncertainty for health plans and delivery systems preparing 2027 network, quality, and compliance strategies.