Exchange Enrollment Down
About 23M have enrolled in Exchange coverage as open enrollment has all but closed out. That’s down about 5% from 2025 but more than the 21.3M in 2024. Interestingly, the reduction is not what many thought it would be after the expiration of the enhanced premium subsidies.
About 3.4 million are new enrollees, while 19.6 million are returning. About 15.8 million people enrolled on the federal Healthcare.gov platform, while 7.2 million enrolled on the state-based Exchanges.
Some states that stepped in with subsidies of their own saw strong growth, as did others who did not – such as Texas. Nine states had enrollment growth, while 41 saw declines.
For the 30 HealthCare.gov states, the data is through Jan. 15. For the 20 state-based exchanges plus D.C., the data is through Jan. 10. There are a few states that extended open enrollment and thus the enrollment numbers could rise. The big unknown is will rolls fall as people are required to make payments and do not do so after a grace period. Thus, 2026 could see more disenrollments.
In other news, talks to extend the enhanced subsidies in some form have ended and the GOP is preparing a last best offer to the bipartisan group. Discussions revolved around a possible two-year extension of the subsidies with subsidy income limits, minimum premiums, and expanded use of health savings accounts (HSAs).
Additional articles: https://www.healthcaredive.com/news/affordable-care-act-enrollment-2026-cms-snapshot-23-million/810790/ and https://www.beckerspayer.com/payer/aca/gop-senators-prep-best-and-final-offer-on-aca-subsidy-extension/ and https://thehill.com/policy/healthcare/5712648-obamacare-enrollment-drops-subisides-expiration/?tbref=hp and https://www.kff.org/quick-take/aca-signups-are-down-but-still-an-incomplete-picture/ and https://www.beckerspayer.com/payer/aca/aca-enrollment-falls-to-23-million-for-2026/
#healthcare #coverage #exchanges
https://www.fiercehealthcare.com/regulatory/about-23m-have-signed-aca-coverage-so-far-cms
Government Shutdown Likely Averted — Sort Of
Earlier today, a partial shutdown looked almost certain after a bipartisan deal to pass a set of appropriations bills failed to receive the needed 60 votes. Many Democrats as well as seven Republicans were off the bill. The Democrats opposed the measure due to concerns over the conduct of the Department of Homeland Security (DHS).
By the day’s end, though, the White House had struck a deal with Senate Democrats to fund the rest of government for the year and the DHS for two weeks to allow negotiations over immigration reforms in light of the killings and activities in Minnesota.
The Senate was expected to vote before the weekend, but objections were raised by some GOP senators late Thursday over some provisions (the length of the DHS funding and the ability of senators to sue for privacy violations with government funds). It will be up to the House leaders to keep all Republicans on the bill. Conservatives were opposed to splitting DHS funding out. The House does not come back until Monday. Even if the Senate passes a bill tomorrow and the House passes the package Monday, there technically will be a short partial shutdown as the deadline ends at midnight Friday/Saturday.
Additional articles: https://www.fiercehealthcare.com/providers/partial-government-shutdown-looms-threatening-stall-health-funding-package-telehealth and https://www.beckershospitalreview.com/hospital-management-administration/shutdown-looms-whats-at-stake-for-healthcare/ and https://www.modernhealthcare.com/politics-regulation/mh-senate-funding-bill-ice-dhs/ and https://www.modernhealthcare.com/politics-regulation/mh-trump-senate-democrats-deal-shutdown/ and https://thehill.com/homenews/senate/5713935-senate-deal-shutdown-funding
(Some articles may require a subscription.)
#governmentshutdown #congress #trump
https://thehill.com/homenews/senate/5714316-senate-government-funding-shutdown
Provider Tax Regulation Finalized
The Trump administration finalized a key Medicaid regulation that reins in provider taxes as passed in the One Big Beautiful Bill Act (OBBBA). The provider taxes on various healthcare entities help fund the state share of Medicaid. Some have said the taxes have become abusive. The OBBBA reins their use, bars future taxes, and reduces the allowable percentage over time.
(Article may require a subscription.)
#medicaid #providertaxes #states
https://www.modernhealthcare.com/politics-regulation/mh-cms-provider-tax-state-medicaid-requirements
Other Healthcare Developments
Pharmacy benefit managers would have to follow new transparency requirements under a proposed rule issued by the federal Labor Department. PBMs would be mandated to disclose information to large group employers about drugmaker rebates, pharmacy reimbursements, and other negotiated compensation.
Combined profit margins across Blue Cross and Blue Shield plans dropped to1.4% as of Q3 2025. BCBS plans account for 37.2% of U.S. health insurance enrollment, or 119.1 million members.
Insurers continue to fret about the neat flat Medicare Advantage (MA) rate hike proposed for 2027. It points to the fact that Trump may be focused on Medicare cost constraint and reform.
Additional articles: https://www.modernhealthcare.com/insurance/mh-pbm-rebates-labor-deparment-proposed-rule/ and https://www.beckerspayer.com/financial/bcbs-profit-margins-fall-to-1-4-3-notes/
(Some articles may require a subscription.)
#healthcare #erisa #pbms #bcbsa #medicareadvantage
https://www.politico.com/news/2026/01/28/trump-proposal-signals-medicare-austerity-00751365
Life Expectancy At Highest Ever
People in the United States are living longer than ever before, according to new data from the Centers for Disease Control and Prevention (CDC). The CDC finds that life expectancy of a person living in the U.S. was 79 years old in 2024, an increase of half a year compared with 2023.
Female life expectancy increased to 81.1 years in 2023 to 81.4 years in 2024. Male life expectancy went from 75.8 years in 2023 to 76.5 years in 2024.
Life expectancy in other developed world countries is still much higher.
#lifeexpectancy #publichealth #healthcare
— Marc S. Ryan
