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Nicole Rapfogel

@nicolerapfogel.bsky.social
269 followers 140 following 73 posts

health policy nerd | sr policy analyst @centeronbudget.bsky.social | formerly CMS and @americanprogress.bsky.social | opinions mine

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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 23/07/2026
New CBO report projects that federal subsidies for employer coverage will be 6X larger than ACA marketplace premium tax credits over 2026-2036. [1/5] www.cbo.gov/publication/...
cbo.gov
Federal Subsidies for Health Insurance, 2026 to 2036
Federal subsidies for health insurance total $33.6 trillion over the 2026–2036 period in CBO and JCT’s projections. Those estimated subsidies grow from 7.4 percent of gross domestic product (GDP) in 2...
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Reposted by Nicole Rapfogel
Claire Heyison @claireheyison.bsky.social · 20/07/2026
Nearly every state saw ACA marketplace enrollment drop after the PTC enhancements expired, but some states fared worse than others. See how your state was impacted: www.cbpp.org/blog/aca-mar...
cbpp.org
ACA Marketplace Enrollment Shrank in Nearly Every State After Premium Tax Credit Enhancements Expired
Enrollment in the Affordable Care Act marketplaces shrank in nearly every state after premium tax credit enhancements expired.
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 27/06/2026
New data show that #ACA marketplace enrollment fell by ~3 million people as premiums spiked following the failure of Congressional Republicans to extend PTC enhancements. This is Feb 2026 data - expect further coverage loss as the year goes on and monthly premiums pile up.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 25/06/2026
With millions struggling to afford health care and coverage, Trump and Republicans in Congress have once again pointed to expanding health savings accounts (HSAs) as a solution. But HSAs don’t solve affordability problem. Here are 5 reasons why: 🧵
cbpp.org
Five Reasons HSAs Aren’t the Answer to the Health Care Affordability Crisis
In the wake of their actions that have worsened health care affordability, President Trump and some in Congress have pushed expanding health savings accounts (HSAs). The problem is HSAs are not the an...
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Reposted by Nicole Rapfogel
Sarah Lueck @sarahl202.bsky.social · 25/06/2026
As some House Rs call for reconciliation 3.0, many want to expand health savings accounts. But HSAs mainly benefit higher-income people, and they do little to improve affordability for those struggling the most with health costs. read more by @nicolerapfogel.bsky.social www.cbpp.org/blog/five-re...
cbpp.org
Five Reasons HSAs Aren’t the Answer to the Health Care Affordability Crisis
In the wake of their actions that have worsened health care affordability, President Trump and some in Congress have pushed expanding health savings accounts (HSAs). The problem is HSAs are not the an...
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 26/05/2026
My colleague @nicolerapfogel.bsky.social and have a new blog on the final ACA marketplace rule for 2027, which weakens consumer protections and pushes people towards lower-quality plans that put them at risk of higher out-of-pocket costs. www.cbpp.org/blog/new-fin...
cbpp.org
New Final Rule Pushes Marketplace Enrollees Toward Lower-Quality, More Expensive Coverage
A new Affordable Care Act marketplace rule finalized by the Centers for Medicare & Medicaid Services adds to the burdens of millions of people in the United States who are already struggling to afford...
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Reposted by Nicole Rapfogel
Claire Heyison @claireheyison.bsky.social · 01/05/2026
Today is #Oklahoma ’s first day as a state-based marketplace on the federal platform (SBM-FP). The state will now certify #ACA plans and run its own consumer outreach program. The change was approved less than a month ago, making this the fastest SBM-FP transition to date. A few things to watch 👀
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Reposted by Nicole Rapfogel
Claire Heyison @claireheyison.bsky.social · 27/04/2026
When Marketplace enrollees filed their taxes this spring, they may not have realized it’d be the last year with key financial protections in place. Starting next year, they’ll face higher taxes due to the Republican megabill. www.cbpp.org/blog/marketp...
cbpp.org
Marketplace Enrollees Could Face Surprise Tax Increases Next Year Thanks to the Republican Megabill
Eliminating the APTC repayment caps is expected not only to reduce marketplace enrollment over time but also to raise premium costs for those who remain enrolled.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 24/04/2026
The Trump admin and Congressional Republicans have pushed to expand health savings accounts. But as I told @nytimes.com, “Health savings accounts are effectively a tax shelter for the wealthy.” More on why HSAs don't help people with low incomes access comprehensive coverage and afford care 👇
cbpp.org
Health Savings Accounts Can Be a Bad Deal for Low-Income Marketplace Enrollees
In the wake of their actions that have worsened health care affordability, President Trump and Republicans in Congress have pushed to expand health savings accounts (HSAs). But this doubles down on an...
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Reposted by Nicole Rapfogel
Claire Heyison @claireheyison.bsky.social · 15/04/2026
Following the expiration of PTC enhancements, #ACA marketplace plan selections dropped by 1.2 million during the 2026 open enrollment period. A new analysis suggests that millions more will drop coverage over the year as enrollees confront higher monthly premiums. www.wakely.com/blog/who-pai...
wakely.com
Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market - Wakely
A new report from Wakely Consulting Group, an HMA Company, models changes to the 2026 ACA market enrollment due to the loss of federal subsidies. Findings
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 06/04/2026
I was out last week. Maybe you were, too? ICYMI, great recap from my colleague @nicolerapfogel.bsky.social of what we learned from the recent CMS #ACA marketplace open enrollment data published the week before last. 👇
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Nicole Rapfogel @nicolerapfogel.bsky.social · 02/04/2026
Following the expiration of enhanced PTCs, new 2026 open enrollment data show marketplace enrollees are paying much more for coverage—even as they shift into lower-premium but less generous plans that leave them with higher deductibles when they need care. 🧵
cbpp.org
New Data Show Marketplace Consumers Facing Higher Costs, Selecting Lower-Quality Coverage
New open enrollment data for 2026 show that people are paying much more for marketplace coverage following the expiration of premium tax credit (PTC) enhancements, even as they shift into lower-premiu...
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Nicole Rapfogel @nicolerapfogel.bsky.social · 23/02/2026
Marketplace enrollees’ premiums have skyrocketed following the recent expiration of PTC enhancements. Some have suggested health savings accounts and less generous plans as a more affordable alternative to comprehensive coverage. Here’s why that line of reasoning is flawed: 🧵
cbpp.org
Health Savings Accounts Can Be a Bad Deal for Low-Income Marketplace Enrollees
In the wake of their actions that have worsened health care affordability, President Trump and Republicans in Congress have pushed to expand health savings accounts (HSAs). But this doubles down on an...
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Nicole Rapfogel @nicolerapfogel.bsky.social · 13/02/2026
On the heels of expired PTC enhancements that resulted in 1 million—and counting—fewer people enrolling in #ACA marketplace plans for 2026, CMS released a proposed rule for 2027 that would reduce marketplace enrollment by 2 million people in 2027 alone. @claireheyison.bsky.social explains:
cbpp.org
CMS Proposed Rule Would Reduce ACA Marketplace Enrollment by 2 Million People
February 09, 2026: A new proposed rule from the Centers for Medicare and Medicaid Services (CMS) to make broad changes to the Affordable Care Act (ACA) marketplaces would reduce marketplace enrollment...
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 08/01/2026
The House passed a measure today to extend the Premium Tax Credit enhancements for three years. The bipartisan vote shows there’s strong support for immediate action to make millions of people’s health care more affordable. All eyes are now on the Senate. x.com/JakeSherman/...
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 06/01/2026
This week, the House is expected to vote on a bill to extend the Premium Tax Credit enhancements. This would reduce 2026 premiums for the average #ACA marketplace enrollee by more than half, improving affordability for millions of people struggling with health costs. www.cbpp.org/research/hea...
cbpp.org
Marketplace Enrollees In Every Congressional District Face Steep Premium Increases Unless Tax Credit Enhancements Are Extended
Annual premium increase, 60-year-old couple with income of $85,000 (401% FPL), by congressional district, 119th Congress Note: FPL = federal poverty level. Examples are based on 2026 average...
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Reposted by Nicole Rapfogel
Kristin @kristinceleste.bsky.social · 16/12/2025
What a mess: "For example, a 60-year-old earning $63,000 would face a premium for a silver plan of $17,200 per year – more than one-fourth of their annual income..."
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Nicole Rapfogel @nicolerapfogel.bsky.social · 16/12/2025
The House Republicans’ response to expiring premium tax credit enhancements simply doesn’t respond to expiring PTC enhancements. Instead, they recycle old Republican policy priorities and do nothing to address the impending marketplace affordability crisis.
cbpp.org
House Republican Health Care Bill Fails to Address Marketplace Affordability
The health bill House Republicans are preparing to bring to the floor this week not only fails to prevent imminent premium spikes for more than 20 million people in marketplace plans, but would raise....
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Reposted by Nicole Rapfogel
Center on Budget and Policy Priorities @centeronbudget.bsky.social · 11/12/2025
This week is critical for health coverage affordability. CBPP’s @jenniferlsullivan.bsky.social breaks down what’s at stake as Congress votes on extending premium tax credit enhancements & the 3 key dates marketplace enrollees need to know when choosing 2026 coverage: www.youtube.com/watch?v=6QY5...
youtube.com
3 Key Dates to Keep in Mind When Choosing Your Health Coverage Plan for 2026
YouTube video by Center on Budget and Policy Priorities
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Reposted by Nicole Rapfogel
Center on Budget and Policy Priorities @centeronbudget.bsky.social · 09/12/2025
Tracy, 57, from GA, received this notice showing her #ACA marketplace premium rising from $82 to $1,616/month if premium tax credit enhancements expire — nearly a $19k increase next year. For her, that means choosing between coverage and essentials.
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Reposted by Nicole Rapfogel
MomsRising @momsrising.org · 09/12/2025
Even small premium payments make it more difficult to enroll in and maintain health coverage, especially for people with low incomes. If the enhanced tax credits expire the cost will hurt millions of families. Via @CenterOnBudget: momsrising.org/CBPPpremiumplans #TrumpInflationCrisis
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 08/12/2025
Sens Cassidy and Crapo are circulating a health proposal that would do little to address the premium spikes millions of ACA marketplace enrollees will face starting Jan 1, and would further increase many people’s out of pocket costs for health care over time. www.axios.com/2025/12/08/s...
axios.com
Scoop: Senate GOP chairs circulate health plan as ACA subsidies hang in the balance
Two key Republican chairmen circulated the plan as the GOP struggles to unite around health policies.
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 05/12/2025
New HHS data on ACA marketplace enrollment for 2026 so far suggest a similar number of ppl have selected a plan compared to last year even as they see higher premium costs that reflect expiration of PTC enhancements. But don't make too much if it.
cms.gov
Marketplace 2026 Open Enrollment Period Report: National Snapshot | CMS
Marketplace 2026 Open Enrollment Period Report: National Snapshot
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Nicole Rapfogel @nicolerapfogel.bsky.social · 08/12/2025
Sweeping federal policy changes are threatening people's access to affordable health coverage and care — but state insurance regulators and other state leaders can help stem the damage. A new report from NAIC consumer representatives explains how:
consumeradvocacyforhealth.org
NAIC Consumer Representative Report: Recommendations for States’ Efforts to Mitigate Harms Caused by Federal Policy Actions - Consumer Health Reps at NAIC
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Nicole Rapfogel @nicolerapfogel.bsky.social · 04/12/2025
As new proposals addressing expiring PTC enhancements emerge, it's important to be clear about what makes a strong (or not so strong) proposal. My colleague @jenniferlsullivan.bsky.social lays out key guidelines for evaluating these proposals.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 02/12/2025
Instead of a clean extension of PTC enhancements (which makes silver plans more affordable), some Republicans have proposed encouraging people to buy down to less generous bronze plans. Don’t be fooled: While bronze plans often have lower premiums, people face much higher costs when they get care.
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 02/12/2025
ACA marketplace plans w/ $0 premiums help ppl get & stay covered. Recent Republican proposals would require minimum premiums or fail to extend premium tax credit enhancements based on the false claim that ppl who don’t use medical care are “phantom enrollees.” 🧵https://tinyurl.com/4uc68zbf
tinyurl.com
People With Low Incomes May Lose $0 Premium Plans — a Lifeline — Unless Congress Acts
Without congressional action, PTC enhancements will expire at the end of 2025. This will cause millions —many of these lowest-income enrollees especially — to become uninsured, or to face impossible c...
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Nicole Rapfogel @nicolerapfogel.bsky.social · 26/11/2025
As I was quoted in this article: "Most people do not have spare cash to set aside in HSAs." HSAs don't help the people with low and moderate incomes most affected by expiring PTC enhancements, don't help people get health coverage, and just don't make sense for most Americans.
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 24/11/2025
Some recent Republican responses to the marketplace premium tax credit issue would shift more people to bronze plans with Health Savings Accounts as an alternative to silver plans with PTC enhancements and cost sharing reductions. So how do these plans stack up in real terms?
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Nicole Rapfogel @nicolerapfogel.bsky.social · 24/11/2025
The GAO released a report last week on health savings accounts (HSAs) reaffirming that HSAs do little to help people with low and moderate incomes – who would be hurt the most if Congress lets premium tax credit enhancements expire.
files.gao.gov
GAO-25-107480, HEALTH SAVINGS ACCOUNTS: Information on Features and Use, and Characteristics of Account Holders
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Reposted by Nicole Rapfogel
Sarah Lueck @sarahl202.bsky.social · 20/11/2025
Here they go again: Republicans in Congress are reviving the ACA repeal debate. After enacting unprecedented cuts to Medicaid, they are looking for ways to eliminate federal premium tax credits that some help about 20M people afford marketplace plans.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 19/11/2025
Today, the Senate Finance Committee held a hearing on rising health care costs. But the real, urgent focus should be that 20 million people would face higher premium costs if the PTC enhancements expire at the end of the year. Here’s how real people will are affected.
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 13/11/2025
My colleague @nicolerapfogel.bsky.social talked with CQ this week about why Republican HSA and cash account proposals are no substitute for extending the soon-to-expire PTC enhancements that more than 20 million ACA marketplace enrollees rely on to keep coverage affordable.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 13/11/2025
As I told CQ, the Republican HSA and other cash account proposals are no real alternative to extending PTC enhancements and won't make health coverage more affordable. “These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
plus.cq.com
CQ NEWS House GOP not ready to embrace Senate’s health account idea
Republicans, who had been unified on the need to reopen the government, seemed less united Wednesday on the next step — how to address the upcoming health care subsidy cliff.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 11/11/2025
Expanding HSAs would do nothing to address impending premium increases for some 22 million people with low/moderate incomes who are facing higher costs. Instead, Congress should extend premium tax credit enhancements to ensure enrollees continue to have access to affordable health coverage.
cbpp.org
Expanding Health Savings Accounts Would Do Little to Improve Access to Affordable Health Care
Amid the urgent debate over whether Congress will act to prevent cost increases for millions of people in 2026 marketplace plans, some Republicans are promoting expansions of health savings accounts.....
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 11/11/2025
HSAs are tax shelters masquerading as health policy. They don't help people who are struggling to afford health coverage. Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx
tinyurl.com
Expanding Health Savings Accounts Would Do Little to Improve Access to Affordable Health Care
Amid the urgent debate over whether Congress will act to prevent cost increases for millions of people in 2026 marketplace plans, some Republicans are promoting expansions of health savings accounts.....
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Reposted by Nicole Rapfogel
Center on Budget and Policy Priorities @centeronbudget.bsky.social · 05/11/2025
Open enrollment for #ACA marketplace plans has begun, and without congressional action to extend premium tax credit enhancements, millions are facing steep premium increases for 2026.
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 07/10/2025
Georgia’s 2026 ACA marketplace window shopping began October 1, meaning people are already seeing next year’s premiums spike because of expiring tax credit enhancements. A typical 60-year-old couple making $85,000 in Georgia will face a $24,900 increase in annual premiums. (1/4)
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Jennifer Sullivan @jenniferlsullivan.bsky.social · 06/10/2025
Some policymakers say that that Congress can delay extending the Premium Tax Credit (PTC) enhancements until later this year but the problem is more urgent than that. thehill.com/policy/healt...
thehill.com
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 02/10/2025
Since 2021, ACA marketplace enrollment more than doubled for people with low incomes and for Black and Latino enrollees after premium tax credit enhancements. (1/4)
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 01/10/2025
Premium tax credit enhancements help tipped workers, veterans, small business workers, farmers, and older people afford health coverage. Their premiums will soon spike and millions of them will lose coverage if the enhancements expire. (1/5)
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Reposted by Nicole Rapfogel
Shelby Gonzales @shelbytgonzales.bsky.social · 30/09/2025
As Democrats push to reverse the megabill’s health care cuts and stop imminent cost increases in the marketplaces, Republicans have made false claims about who would benefit from these restorations in affordable health coverage. www.americanprogressaction.org/article/repu...
americanprogressaction.org
Republicans Are Telling Lies About Undocumented Immigrants To Deflect Blame for Health Care Cost Increases They Supported
Republican inaction on premium tax credits will cause health insurance costs to soar for more than 20 million people.
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Reposted by Nicole Rapfogel
KFF @kff.org · 30/09/2025
If Congress allows the enhanced premium tax credits to expire at the end of this year, ACA Marketplace enrollees on average would see their out-of-pocket premium payments grow by 114%, from an average of $888 in 2025 to $1,904 in 2026: on.kff.org/3WfWxjj
KFF bar chart titled “Premium payments in 2026 would more than double on average if ACA Enhanced Premium Tax Credits Expire.” The chart shows the annual out-of-pocket premium payments for Affordable Care Act Marketplace enrollees in 2025 and 2026. For 2025, the payment is $888, and for 2026, the projected payment is $1,904. This is an increase of 114%. Note: the 2026 average premium payment assumes gross premiums increase of 18% for those who lose tax credit eligibility.
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 30/09/2025
Why are #ACA marketplace plans with $0 premiums important? My colleague @nicolerapfogel.bsky.social explains:
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Nicole Rapfogel @nicolerapfogel.bsky.social · 30/09/2025
NEW from @centeronbudget.bsky.social: Without Congressional action, premium tax credit enhancements will expire, raising costs for nearly all marketplace enrollees and putting millions of those with the lowest incomes at risk of becoming uninsured when they lose $0 premium plans.
cbpp.org
People With Low Incomes May Lose $0 Premium Plans — a Lifeline — Unless Congress Acts | Center on Budget and Policy Priorities
Everyone should be able to get the health care they need to thrive, and for that to happen, it must be affordable, high quality, and easily accessible for all. Premium tax credit (PTC) enhancements...
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Reposted by Nicole Rapfogel
Gideon Lukens @gidlukens.bsky.social · 29/09/2025
More than 2 in 5 veterans enrolled in the ACA marketplace will lose their coverage if premium tax credit enhancements expire, out of the 623,000 veterans who would otherwise have marketplace coverage in 2026. New Urban Institute estimates here: tinyurl.com/2bs4aj2j
tinyurl.com
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Nicole Rapfogel @nicolerapfogel.bsky.social · 23/09/2025
NEW from @jenniferlsullivan.bsky.social and me for @centeronbudget.bsky.social: With Congress poised to take away premium tax credit enhancements soon, ~4M people will lose coverage and costs will rise for nearly all ACA marketplace enrollees unless Congress acts.🧵
cbpp.org
Five Key Changes to ACA Marketplaces Amid Uncertainty Over Premium Tax Credit Enhancements | Center on Budget and Policy Priorities
Recent policy changes, most notably enhancements to premium tax credits to reduce enrollees’ health insurance premiums, have driven record-breaking enrollment gains and delivered reduced costs, simpli...
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Reposted by Nicole Rapfogel
Jennifer Sullivan @jenniferlsullivan.bsky.social · 22/09/2025
My colleague @nicolerapfogel.bsky.social and I write about five key changes coming to #ACA marketplaces this fall. TLDR? Nearly all enrollees will face higher costs unless Congress extends the Premium Tax Credit enhancements.
cbpp.org
Five Key Changes to ACA Marketplaces Amid Uncertainty Over Premium Tax Credit Enhancements | Center on Budget and Policy Priorities
Recent policy changes, most notably enhancements to premium tax credits to reduce enrollees’ health insurance premiums, have driven record-breaking enrollment gains and delivered reduced costs, simpli...
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Reposted by Nicole Rapfogel
Center for American Progress @americanprogress.bsky.social · 06/08/2025
Eliminating the PMF program as President Trump ordered could mean losing a new generation of bright public servants. PMF alums @andrewpmiller.bsky.social and Kelly Razzouk explain in @justsecurity.org:
justsecurity.org
Save the PMF Program or Risk Losing a Generation of Public Servants
The Trump administration's elimination of the PMF program will have negative long-term consequences for an entire generation of policymakers.
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Nicole Rapfogel @nicolerapfogel.bsky.social · 10/07/2025
In addition to restricting marketplace eligibility and increasing burdensome red tape in the budget bill, CMS finalized a rule that would cause 1.8M people to lose coverage in 2026 alone. More on the details and major issues 👇
cbpp.org
June 20, 2025: Executive Action Watch | Center on Budget and Policy Priorities
The Centers for Medicare & Medicaid Services (CMS) finalized a rule that will make Affordable Care Act marketplace coverage less affordable for enrollees, create new barriers to enrolling in and...
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