Affordable Care Act and Health Insurance

Open enrollment ends in most states as enhanced ACA premium tax credits have lapsed, with sign‑ups down to 22.8 million—about 1.4 million fewer than a year ago—and analysts warn premiums for subsidy recipients could more than double (KFF estimates a ~114% jump), a change the CBO says could ultimately leave roughly 4 million people uninsured without congressional action. The House advanced a three‑year "clean" extension in a 221–205 procedural vote after several Republicans crossed party lines, but Senate negotiations are near collapse over proposed limits on abortion coverage—pressure from anti‑abortion groups has complicated a deal—leaving a fix uncertain even though Congress can still extend subsidies retroactively and several states have extended enrollment deadlines.

President Trump’s "Great Healthcare Plan" is a high‑level four‑pillar framework — drug pricing, insurance reforms, price transparency and fraud protections — that the White House says would redirect federal payments “directly to you,” potentially by routing funds into health savings accounts (HSAs), but it provides no legislative text or operational details. Experts and Democrats warn it does not address the lapse of enhanced ACA premium subsidies and could leave lower‑income and ACA enrollees worse off, since HSAs skew to higher‑income users and the approach could encourage non‑comprehensive coverage that undermines ACA protections.