In this edition of AcademyHealth’s Situation Report, we examine growing uncertainty in federal health policy as Congress stalls on extending enhanced ACA subsidies, leaving states and insurers scrambling just days before open enrollment. We also track implementation challenges around Medicaid work requirements, expansion efforts by major insurers amid subsidy uncertainty, and the precarious funding outlook for WIC as the government shutdown stretches into its third week. Finally, we highlight various AcademyHealth offerings, including a timely opportunity to strengthen your communication skills and counter misinformation through our upcoming course, Communicating to Build Trust as well as our Health Policy Orientation which offers a crash course in health policymaking and how to make an impact.
In today’s issue:
- Officials Warn Time is Running Out to Extend ACA Subsidies
- Without Final CMS Guidance, States Face Tight Deadlines for Medicaid Work Requirements
- Major Health Insurers Expand Market for Individual Health Insurance Under the ACA Amid the Congressional Battle Over ACA Tax Credits
- WIC Backed by Evidence, Threatened by Budget Disputes
- AcademyHealth Featured in Health Affairs: Federal Medicaid Reforms Risk Worsening Maternal Health Disparities
- Why Facts Alone Don’t Fix Misinformation: Register for AcademyHealth's Course on Building Trust
Officials Warn Time is Running Out to Extend ACA Subsidies
Consumers will begin shopping for 2026 coverage when the Affordable Care Act (ACA) open enrollment begins on November 1. With less than two weeks to go, state insurance officials worry that Congress will not extend enhanced ACA subsidies in time to avoid major disruptions, such as steep premium increases. If the higher rates are not addressed by the time open enrollment begins, even if rates can be adjusted later, states warn that some enrollees could still drop health insurance coverage all together, particularly those who are young and healthy and therefore perceive a smaller risk associated with being uninsured. As a result, ACA costs could increase even further due to a skewed risk pool. So far, however, as the government shutdown continues into its third week, there is no sign that a deal to extend the subsidies is imminent. ACA enrollment sign-ups surpassed 23 million this year; however, if the subsidies lapse, the Congressional Budget estimates that 2.2 million people would lose coverage in 2026.
Moreover, as open enrollment approaches and insurers wait to submit final rates or opt to submit two rates reflecting those with and without subsidies, costly operational challenges at the state level and consequential confusion at a consumer level may be inevitable.
Health services researchers play an imperative role in understanding how both the delay and possible lack of ACA subsidy extension will impact people’s coverage, health, and the ACA as a whole.
Without Final CMS Guidance, States Face Tight Deadlines for Medicaid Work Requirements
Although many components of the new Medicaid work reporting requirements remain unclear, states are already facing tough decisions on how to implement these requirements while awaiting guidance from CMS. In previous attempts to increase eligibility requirements, states have learned what problems could arise when implementing new restrictions and developing new systems. For instance, during the COVID-19 pandemic, states were barred from determining member eligibility; afterwards, many had to restart those assessments. Massachusetts updated its program to run more efficiently and minimize coverage losses. Conversely, when Iowa considered work requirements during the first Trump administration, lawmakers realized that any potential savings from disenrollments would be offset by additional costs to confirm eligibility. Researchers have suggested that the latest work requirements could similarly increase costs for states, especially if CMS does not offer an affordable, standardized blueprint for states to implement these changes by 2027. A group of current and formed Medicaid directors shared that having a head start on the process, including by having participants certify their work hours in their state Medicaid systems ahead of the 2027 deadline, could make the official launch smoother, averting erroneous coverage losses. The implementation of these new policies offers an opportunity for state policymakers to learn from health services researchers focused on implementation science on how best to engage community partners, hospitals, insurers, and enrollees to communicate new requirements.
Major Health Insurers Expand Market for Individual Health Insurance Under the ACA Amid the Congressional Battle Over ACA Tax Credits
Several major health insurers are expanding their market for individual health insurance under the Affordable Care Act (ACA). The plans to expand into new geographic areas and offer more health plan options come as the country approaches its third week of a government shut down hinging on whether Congress will extend ACA tax credits into 2026. It is uncertain as to whether and to what extent insurers will lose customers if premiums rise because of the expired subsidies, but that appears to not have deterred many insurers from expanding their offerings. For instance, Oscar Health, one of the biggest providers of coverage under the ACA, is launching new plans for enrollees with chronic conditions and for women experiencing perimenopause and menopause. Oscar Health will also expand coverage in Alabama and Mississippi for the 2026 health benefit year, offering coverage to a total of 573 counties across 20 states. Similarly, UnitedHealthcare, Cigna, Elevance Health, and Blue Cross and Blue Shield plans are expanding to new geographic areas. So, while these expansion efforts may provide more people with the opportunity to purchase individual health insurance under the ACA, a lapse in the tax credits may make the cost of health insurance too expensive. Lower and middle income folks are expected to be hit hardest, with costs potentially rising up to 75 percent. If Congress allows the tax credits to expire, experts predict that about 7.3 million people will lose subsidized ACA health coverage, causing 4.8 million people to become uninsured. A higher uninsured population means a more strained health system and worse health outcomes, and it is unclear how insurers will respond.
WIC Backed by Evidence, Threatened by Budget Disputes
As the federal government shutdown extends into its third week, critical social service programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) hang in the balance. Many states have warned that a long-term shutdown could put WIC benefits in jeopardy as they would run out of their contingency funding. Since the shutdown began, the U.S. Department of Agriculture has already infused $300 million in unspent tariff revenue from the last fiscal year to keep WIC afloat. However, these funds are projected to only last until the end of October, raising concerns about potential service disruptions affecting millions of Americans if the shutdown persists beyond October 31st.
Backed by 50 years of evidence, WIC has been a cornerstone for promoting the health and nutrition of low-income families. Extensive research has found the federal program to be a cost-effective investment that spurs multiple benefits, including healthier infants and children, more nutritious diets and health care access, and subsequently, higher student academic achievement. Despite these benefits, the program’s operational stability is jeopardized by federal budget disputes as it is discretionary spending. In response to these challenges, 70 House Democrats are proposing the WIC Benefits Protection Act that would guarantee program funding regardless of lapses in government funding or budgetary gridlocks. For health services researchers, this scenario highlights the critical interplay between policy decisions and public health outcomes and the importance of using evidence to inform future policy decisions to safeguard essential health programs from political and fiscal uncertainties.
AcademyHealth Featured Health Affairs: Federal Medicaid Reforms Risk Worsening Maternal Health Disparities
The United States is facing a growing maternal health crisis, with increasing rates of preventable maternal mortality and persistent disparities across racial, geographic, and socioeconomic lines. Medicaid, which covers over 40 percent of births nationwide, plays a critical role in ensuring access to care during pregnancy and the postpartum period. Recent federal policy changes enacted through a budget reconciliation package introduce new eligibility restrictions, reduce funding flexibility for states, and limit coverage options for immigrants. These changes are projected to result in substantial coverage losses, diminished access to care, and adverse health outcomes for pregnant and postpartum individuals.
In a recent Health Affairs Forefront article, AcademyHealth staff members Annaleise Johnson, Zoe D’Angelo, and Susan Kennedy examine the scope and implications of these policy shifts. Drawing on evidence from past state-level implementation efforts and existing research, the authors assess how the proposed changes could exacerbate maternal health inequities and strain health systems, especially in rural and underserved communities. The authors also offer recommendations for state policymakers to mitigate harm, maintain access to essential services, and protect the health of pregnant and postpartum populations. This analysis reflects AcademyHealth's ongoing commitment to evidence-informed policymaking in advancing health equity and improving outcomes.
Why Facts Alone Don’t Fix Misinformation: Register for AcademyHealth's Course on Building Trust
In a new blog post, AcademyHealth CEO Aaron Carroll explores why traditional methods of countering misinformation often fail and includes tips for what actually works, including proven strategies like, fact-first framing and using trusted messengers to connect with audiences more effectively.
At a time when confusion outpaces clarity — especially during the ongoing government shutdown — researchers, policymakers, and communicators face a critical need to rebuild public trust. AcademyHealth’s new course, Communicating to Build Trust, which includes live sessions, small-group work, and practical guidance for applying these tools in your own setting from expert faculty, is designed to empower researchers not to shy away from public communication, but to confidently step up to make a meaningful impact with their work. Register here by October 24.
Previous Editions
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.