Trump Administration and Congress Reduce Federal Health Spending at the Expense of States, Consumers, and Millions of Newly Uninsured

Commonwealth Fund August 13, 2025
Rachel Swindle, Justin Giovannelli

TOPLINES

New policies will dramatically alter how the Affordable Care Act marketplaces operate, imposing substantial costs and burdens on states and the many residents who rely on the marketplaces for coverage

New policies will take effect soon, meaning state-based marketplaces won’t have much time to prepare staff, enrollment partners, and consumers for a long list of changes

A recently finalized federal regulation and the new budget reconciliation law will dramatically alter how the Affordable Care Act’s (ACA) marketplaces operate, imposing substantial new costs and burdens on states and the many residents who rely on the marketplaces for coverage. State-based marketplaces (SBMs) will now be forced to implement massive technological changes, modify integration with state Medicaid programs that are facing their...

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