Tracking Emerging Public Health Challenges – February 26, 2026 – Obamacare Subsidies
Under the proposal, people who rely on the Affordable Care Act for their health insurance coverage could choose plans with much lower monthly premiums. But that could leave them exposed to medical expenses totaling thousands of dollars more than A.C.A. plans do now before their insurance would kick in.”
“Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, which oversees the Obamacare markets, promoted the new proposal. “The goal is simple: lower costs, more choice, and exchanges that work as intended,” he said. The agency declined to make anyone available to discuss the proposal.
Critics of the new approach warn that consumers are already abandoning costly health insurance coverage. More than a million people have dropped out of Obamacare this year to date, a decline that many attribute to a decision by the Republican-controlled Congress to let enhanced subsidies expire at the end of last year.”
“Dr. Oz’s new proposal would allow one kind of health plan to raise the annual deductible to more than $15,000 for an individual and $31,000 for a family; those are much higher than current Obamacare plans. The individual deductible would be eight times the average for someone with job-based insurance.” (1)
How CMS plans to transform the health insurance exchanges http://www.modernhealthcare.com/politics-regulation/mh-cms-aca-rule-state-based-exchanges/
“To me, this proposal reads like the administration has found their next big thing in the catastrophic plans,” said Katie Keith, director of the Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center.
Such plans have very high annual out-of-pocket costs for the policyholder but often lower premiums than other ACA coverage options. Formerly restricted to those under age 30 or facing certain hardships, the Trump administration allowed older people who lost subsidy eligibility to enroll in them for this year. It is not yet known how many people chose to do so.
The payment rule cements this move by making eligible anyone whose income is below the poverty line ($15,650 for this year) and those earning more than 2.5 times that amount who lost access to an ACA subsidy that lowered their out-of-pocket costs. It also notes that a person meeting these standards would be eligible in any state — an important point because this coverage is currently available in only 36 states and the District of Columbia.
In addition, the proposal would require out-of-pocket maximums on such plans to hit $15,600 a year for an individual and $27,600 for a family, Keith wrote this week in Health Affairs. (The current out-of-pocket max for catastrophic plans is $10,600 for an individual plan and $21,200 for family coverage.) Not counting preventive care and three covered primary care doctor visits, that spending target must be met before a policy’s other coverage kicks in.” (2)
“The kicker is that high deductible catastrophic plans may not even save consumers money. Bronze plans have the lowest premiums and highest deductibles on the ACA exchanges. A comparison of Bronze and catastrophic plans in 2026 by KFF, a health policy research institute, raises questions about whether the catastrophic plans with their skimpy benefits are actually the cheapest option. The deductible in catastrophic plans today is $10,600 for individual policies. For the average Bronze plan today, the deductible is $7,476 for an individual. The average monthly premium for the lowest-cost catastrophic plan is $346 this year, compared with an average $369 for a person 27 years of age with an unsubsidized Bronze plan. Meanwhile, the Bronze plan comes with all the robust standard coverages required by the ACA for plans on the exchange.” (3)
“In the first State of the Union address of his second term, President Trump on Tuesday touted economic wins, including on health care, even as more than half of Americans say health care has become more unaffordable for them and their families.
In his speech, Trump claimed he had brought prescription drug costs from the highest in the world to the lowest, thanks to his “most-favored nation” policy. And he implored congressional Republicans to codify the policy into law.
“It’s going to be very hard for somebody that comes along after me to say, ‘Let’s raise drug prices by 700 or 800%.’ But John and Mike, if you don’t mind, codify it,” he said, directly addressing Senate Majority Leader John Thune (R-S.D.) and House Speaker Mike Johnson (R-La.). Most-favored nation pricing is not popular among Republican lawmakers, who’ve shied away from addressing the issue. The trade group PhRMA has also opposed the policy, with the group’s president and CEO, Stephen Ubl, saying in a statement Tuesday night, “Government-imposed Most Favored Nation policies would undermine U.S. competitiveness while doing nothing to address insurance practices that deny care and raise costs for patients.”” (4)
“President Donald Trump used his State of the Union address Feb. 24 to plug TrumpRx, criticize the ACA and call out possible Medicaid fraud.
Here are six things President Trump said about healthcare and related policies:
1. What’s next after the enhanced ACA subsidy expiration
2. TrumpRx moves forward
3. ‘The war on fraud’ for Medicaid, a commitment to Medicare
4. Newly imposed tariffs
5. New retirement plan
6. The One Big Beautiful Bill Act (5)
1.New A.C.A. Plans Could Increase Family Deductibles to $31,000, By Reed Abelson,https://www.nytimes.com/2026/02/26/health/obamacare-health-insurance-rollbacks.html?smid=nytcore-ios-share
2.Trump Team’s Planned ACA Rule Offers Its Answer to Rising Premium Costs: Catastrophic Coverage, By Julie Appleby, https://kffhealthnews.org/news/article/aca-trump-proposal-catastrophic-coverage-premiums-care-networks/
3.Trump Team’s Planned ACA Rule Offers Its Answer to Rising Premium Costs: Catastrophic Coverage, By Julie Appleby, https://kffhealthnews.org/news/article/aca-trump-proposal-catastrophic-coverage-premiums-care-networks/
4.Trump touts lower drug costs and anti-fraud measures in lengthy State of the Union, By Chelsea Cirruzzo and John Wilkerson, https://www.statnews.com/2026/02/24/trump-state-union-health-plan-drug-prices-maha/
5.Trump’s State of the Union: 6 healthcare takeaways, By: Elizabeth Casolo and Kristin Kuchno, https://www.beckershospitalreview.com/hospital-management-administration/trumps-state-of-the-union-6-healthcare-takeaways/?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2126A8677690F9V
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai