AHIP Continues to Raise Awareness of Cost Impacts if Congress Fails to Extend ACA Health Care Tax Credits

November 13, 2025

marketplace

AHIP highlighted multiple media reports this week noting that millions of Americans are getting “their first look at the sharp increases many will pay” if Congress fails to extend the enhanced premium tax credits that have made comprehensive, high-quality health care coverage affordable for 22 million Americans.

The Associated Press reports that the expiring subsidies means premiums will more than double what subsidized enrollees currently pay, with annual premiums estimated to increase by 114%, according to a KFF analysis. CBO analysts estimate the higher prices could cause around two million people to become uninsured next year.

KFF also notes the change may strain hospitals, potentially leading to hospital closures or cost increases, since more uninsured people will seek emergency care they can’t afford. The New York Times reports that some consumers may also have fewer choices because their insurers dropped out of some markets for 2026.

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

EGWP marketplace medicaid Medicare

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

EGWP marketplace medicaid Medicare

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