Aug. 11, 2025
The U.S. Health Care Financing System for 2026: Trends and Implications for Consumers and States
The federal Affordable Care Act (ACA) was the most substantial reform to the U.S. health care system since the enactment of the Medicare and Medicaid programs in the 1960s. Two significant aspects of the ACA were: 1) the provision of subsidies (in the form of advanced premium tax credits) to make health insurance more affordable for low- to middle-income consumers purchasing their own health insurance; and 2) an expansion of the Medicaid program. Although requiring states to expand Medicaid was ruled unconstitutional by the U.S. Supreme Court, a large majority of states expanded Medicaid on their own. The federal American Rescue Plan of 2021 (ARPA) increased the amount of financial assistance available to people already purchasing their own health insurance coverage through the ACA marketplaces and extended subsidies to many with incomes that previously excluded them from subsidies. The federal Inflation Reduction Act (IRA) extended these enhanced subsidies for an additional three years through 2025.
Several provisions being proposed by the current administration and discussed as part of the 2025 Federal Budget Reconciliation Act have the potential to significantly change the U.S. health care financing system again, including substantial changes that could make ACA marketplace and Medicaid coverage less accessible and less affordable. The proposed changes have raised many unknowns and concerns for health care workers, consumer advocates, and state governments.
This program begins with an overview of recently enacted changes to the U.S. health care financing system and the outlook for future health care efforts by the federal government. Next is a brief presentation on the structure and evolution of the U.S. health care financing system post ACA through COVID-19-era adjustments. Following these two presentations, there will be a panel discussion that makes up the bulk of the event. The panel discussion will largely focus on recent changes and proposed changes to the U.S. health care financing system.
Panel Speakers:
Cynthia Cox, Vice President and Director, Affordable Care Act Program
Pat Kelly, Executive Director, Your Health Idaho
J.P. Wieske, Vice President of State Affairs, Horizon Government Affairs
Kelly Edmiston, Policy Research Manager, Center for Insurance Policy and Research
Moderated by:
Brian Webb, Director, Health and Life Policy & Affairs (不良研究所官方)
CIPR's special session is open to all registered 不良研究所官方 2025 Summer National Meeting participants.
About the National Association of Insurance Commissioners
As part of our state-based system of insurance regulation in the United States, the National Association of Insurance Commissioners (不良研究所官方) provides expertise, data, and analysis for insurance commissioners to effectively regulate the industry and protect consumers. The U.S. standard-setting organization is governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the 不良研究所官方, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. 不良研究所官方 staff supports these efforts and represents the collective views of state regulators domestically and internationally.