Tax Credit Turmoil, Cost Pressures Set Stage for Tumultuous ACA Open Enrollment

Healthcare Policy attorney Robert Bradner and Senior Policy Advisor Larry Bucshon were interviewed for a Fierce Healthcare article previewing challenges for the Affordable Care Act (ACA) open enrollment period, which begins Nov. 1, 2025. The ongoing government shutdown, stemming in part from a standoff over extending the enhanced premium tax credits that will expire at the end of this year, complicates enrollment, as insurers and insureds cannot plan with certainty how much insurance will cost without knowing whether the credits will be extended.

Mr. Bradner noted that even if Congress agrees on an extension, some individuals who log on this weekend to enroll will see elevated premiums and decline enrollment, and lawmakers will find it difficult to conduct outreach after the fact. He also talked about other factors that add to uncertainty and elevate premiums, including program integrity measures instituted in rulemaking from the Centers for Medicare & Medicaid Services (CMS). He explained these pressures can prove more significant than the subsidies, even if national conversations have boiled down to them.

"You've got the impact on the rate-making side and then you've got the actual reduced premium tax credit when the person goes to shop, and so it's both of those things," he said. "I think, in a lot of the discussion, people aren't really being careful to analyze these two factors."

For his part, Mr. Bucshon agreed that negotiations on Capitol Hill center on support for an extension but added that voters are "more attuned to this than you would think" because healthcare is a personal matter that directly affects their wallets.

"They just see the premiums going up, and they know there are issues in the system, whether or not they agree with the specific reasons why either party says that's happening," he said. "That doesn't really matter to people, what matters is the price."

READ: Tax Credit Turmoil, Cost Pressures Set Stage for Tumultuous ACA Open Enrollment