ACA at 16: Costs Rise as Oversight Escalates, 2027 Market Rules Proposed

Overview

• CMS has proposed sweeping Affordable Care Act changes for 2027 that would reshape plan flexibility, cost-sharing reductions, quality reporting and risk adjustment.
• House Republicans in February subpoenaed eight major insurers following a GAO report on billions in unreconciled subsidies, as GAO test applications using fictitious identities were largely approved.
• A March 19 KFF survey found 80% of returning marketplace enrollees reported higher costs this year, with 9% of 2025 enrollees now uninsured.
• Provider access concerns persist as analyses show narrower networks have become more common and some consumers are downgrading to bronze plans, including reports of this shift in Texas.
• The policy debate has intensified, with President Trump proposing to route subsidies directly to individuals, Democrats pressing to restore enhanced credits, and some states seeking to offset the loss of federal aid.