Marketplace enrollment could decline between 47% and 57% if premium tax credits expire and proposed changes in Congress become law, according to an analysis from Wakely, a healthcare market research firm .
The “One Big Beautiful Bill,” a 1,000+ page budget reconciliation package, would limit marketplace eligibility for some lawfully present immigrants and will eliminate passive re-enrollment in plans each year.
In addition to changes to the marketplace, Wakely’s analysis gauges the expected expiration of enhanced subsidies for individual coverage. The subsidies have spurred record enrollment in the marketplace and cut average premium payments by 44%, according to KFF. These subsidies will expire at the end of 2025, unless Congress acts to extend them.
The analysis, completed June 18 and published June 23, excludes the effect of a new final rule from CMS that shortens open enrollment periods and requires more stringent eligibility checks. The analysis does include the impacts of the proposed version of the rule.
Here are five things to know:
- Wakely estimates marketplace enrollment will decline by between 11.2 million and 13.6 million enrollees as a result of the proposed changes.
- Most of this decline will be among members receiving subsidies — but nonsubsidized enrollment will decline by between 3.9% and 6.1% due to projected premium increases, Wakely estimated.
- States that have not expanded Medicaid will see especially large declines in marketplace enrollment, ranging between 53% and 64%.
- Wakely estimates the combined effects of expiring subsidies and other changes will increase gross premiums between 7% and 11.5%. These premiums are the pieces paid by individuals not eligible for subsidies. Without enhanced subsidies, annual prices paid by consumers will increase significantly.
- Most of the coverage losses on the marketplace will be due to the end of enhanced subsidies, Wakely estimated. Between 25% and 30% of current marketplace enrollees will no longer purchase coverage without subsidies, Wakely estimated. Program integrity regulations will account for between 8% and 9% decline in enrollment, and the end of passive reenrollment will decrease enrollment between 6% and 12%. Changes in immigrant population eligibility will decrease enrollment by 6%.
Read the full report here.
