Health Affairs December 17, 2025
In the latest survey of leading health care policy scholars conducted by the Cornell Health Policy Center, most leading scholars agreed that proposals to convert enhanced subsidies for Affordable Care Act (ACA) Marketplace plans into contributions for health savings accounts (HSAs) would have an overall effect of worsening health care affordability for enrollees. There was also consensus that requiring small-dollar premiums (instead of permitting fully subsidized plans with no net premium) would measurably reduce Marketplace enrollment; there was further consensus that a scheduled policy change that will effectively end automatic renewals with subsidy will substantially reduce Marketplace enrollment.
Background
At the end of 2025, “enhanced” premium tax credits (ePTCs), which have been available since 2021 to people enrolled in health...
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