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The Waiting Room | Last Call for 2026 Health Coverage & the Senate’s Risky Compromise
Today’s the final day to enroll for 2026 health coverage in most states.
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Charles Gaba is a nationally recognized health care analyst who tracks policy and politics at ACASignups.net. Subscribe to his Substack!
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Greetings, Lincoln Square readers!
When we left off two weeks ago, we were over the New Year’s hump into 2026. The deadline for January 1st ACA coverage had passed in every state (with one exception; see below) … but there was still time for people to sign up for coverage starting in February.
The much-ballyhooed “clean” three-year extension of the enhanced ACA tax credits finally received a vote in the House, where it passed easily with a whopping 17 Republicans giving the finger to Speaker Mike Johnson by crossing over and joining every Democrat in voting for it.
The CBO also came out with their estimates of the impact, concluding that an extra 4 million Americans would gain healthcare coverage while gross premiums would also be reduced significantly. So there you go.
Of course, every one of those House Republicans also knew damned well that the bill was likely dead in the Senate (after all, it had come up nine votes short of cloture there just a couple of months earlier). So this was mostly just a way for them to take one Democratic midterm attack ad off the table.
Interestingly, only 13 of those 17 represent what are generally considered to be swing districts, meaning that there’s another 25 vulnerable House Republicans who just actively voted to raise net premiums by up to 800%.
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Even so, a lot more House GOP members voted for the bill than most expected (it was actually 1 higher than even I predicted), which at least put a lot of pressure on Senate Republicans to put together … something.
Sure enough, that’s exactly what they’re doing. GOP Senators Bernie Moreno of Ohio and Susan Collins of Maine have put their heads together with Democratic Senators Jeanne Shaheen of New Hampshire and Tim Kaine of Virginia to try and come up with a plan to extend the enhanced subsidies, while also getting at least 60 votes for cloture.
While the details are still fluid, the basics of the Senate version seem to be:
Two years (the House version was three years).
Raising the “Subsidy Cliff” income cut-off threshold from 400% to 700% of the federal poverty line (the House version didn’t have any hard cut-off, though tax credits would still taper off to nothing gradually).
A $5/month minimum net premium no matter what (not in the House version).
Giving enrollees the option of taking the enhanced subsidies in the form of Health Savings Account (HSA) funds instead of traditional premium tax credits (not in the House version).
“Possibly” funding Cost Sharing Reduction (CSR) reimbursement payments starting in 2027 (n/a in the House version); this would effectively kill Silver Loading.
More draconian abortion restriction (“Hyde Amendment”) language (not in House version).
I wrote up a deeper dive into my thoughts about each of these provisions (assuming they’re part of the final bill) last week.
The short version: I probably could live with the first three bullets, but the fourth would be a logistical, regulatory, and security nightmare to implement (I could also easily see this opening up millions of bank accounts to some sort of “Trump HSA” crypto scam grift). And the fifth point would dramatically increase net premiums for millions of enrollees permanently (in return for only two years of enhanced subsidies).
As for the sixth (Hyde language), that should be a complete dealbreaker, seeing how the ACA already bends over backward to absurd lengths to avoid federal funds being used to pay for abortions. This also seems to be where Senate Dems are at, thankfully.
The Senate compromise bill language was supposed to be rolled out sometime on Wednesday. But on Tuesday they announced what I’m sure will be a shock: It’s been delayed until the end of January … which, by my calculations, would be …
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By an amazing coincidence, “the end of January” also happens to coincide with the end of the Continuing Resolution bill to keep the federal government functioning which was passed back in November, so that’s another fun factor to keep an eye on …
Meanwhile, the Centers for Medicare & Medicaid Services (CMS), which also oversees the ACA, published the much-anticipated semi-final 2026 Open Enrollment Period Snapshot Report, which updates total enrollment as of either Jan. 3rd or Dec. 27th, depending on the state.
The top-line tally is 22.8 million, down around 834,000 people vs. the same point a year ago. But as I explained a couple of weeks earlier, that figure will likely grow substantially higher by the time the dust settles.
Again: In spite of my repeated warnings, around half the total enrollees allowed themselves to be passively auto-renewed, which means many almost certainly immediately dropped their coverage once they saw the January premium invoice …while others will only be able to stick it out for a few months before having to do so.
On a related note, the “official” average net premium hikes will likely be less than the 114% increase estimated by KFF last fall … but the reasons for this mean it’s definitely NOT cause to celebrate.
As I noted a couple of weeks ago, that estimate assumed that all current enrollees a) remain enrolled and b) renew into the same plan they had last year … neither of which is likely to be the case by a long shot.
I also broke out the semi-final enrollment data in a few different ways and came to one rather interesting conclusion …
While all of THAT is (or isn’t) going on, it’s important to remember that you still have until MIDNIGHT TONIGHT to enroll in exchange coverage effective February 1st in every state except Idaho.
In fact, there are 10 states where the deadline to enroll for Feb. 1st coverage is later than tonight:
California: January 31st
Connecticut: January 31st (extended!)
District of Columbia: January 31st
Illinois: January 31st (extended!)
Massachusetts: January 23rd
New Jersey: January 31st
New York: January 31st
Pennsylvania: January 31st (extended!)
Rhode Island: January 31st
Virginia: January 30th
Washington, meanwhile, is a special case as I alluded to at the top of this post: The final deadline for Open Enrollment is tonight. However, thanks to an emergency Special Enrollment Period caused by recent flooding, you can arrange for your policy to retroactively go into effect as of Jan. 1st instead if you like.
For the last time this go around, don’t forget to review my ACA Open Enrollment Guide if you haven’t already for a bunch of other important info.
And with that, I’ll see you again in … two weeks!
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