The Sleeper Provision in the Reconciliation Bill That Could Hobble the ACA Marketplaces

[MayReasonRule]

The Ways & Means Committee’s provisions on Marketplace coverage in the reconciliation bill include one especially complex section (sec. 112201) that would have major consequences and important interactions with the rest of the package. The provision’s title (“Requiring Exchange Verification of Eligibility for Health Plan”) undersells its importance, since Exchanges–also called Marketplaces–are already required to verify eligibility for health coverage and financial assistance. In fact, this provision would make profound changes to both Marketplace enrollment processes and eligibility for the ACA’s subsidies that help 22.4 million people afford Marketplace coverage.

Sec. 112201 amends the eligibility rules in section 36B of the Tax Code, which created the premium tax credit–the ACA’s primary subsidy to help people purchase coverage. These changes would also carry over to narrow eligibility for cost-sharing reductions (CSRs), the ACA’s primary subsidy to help Marketplace enrollees with deductibles and other cost-sharing.

Sec. 112201 makes two important changes to subsidy eligibility rules. First, it eliminates passive reenrollment, which 10.8 million people relied on to enroll in 2025. Second, it eliminates provisional eligibility, which allows applicants to receive financial assistance for a limited time period while the Marketplace works to confirm they are eligible. These provisions on their own would cause a significant number of people to lose health insurance, but, crucially, they will have even larger impacts if enacted at the same time as other changes being contemplated by the House Energy & Commerce Committee.

This piece is a deep dive into this section, how it would be implemented, its implications, and its interaction with the other health care provisions of the reconciliation package.

https://chirblog.org/the-sleeper-provision-in-the-reconciliation-bill-that-could-hobble-the-aca-marketplaces/

via

For example, I don't think the CBO's projections include this insanity, as laid out by @jasonlevitis.bsky.social & @clinkeyoung.bsky.social:

chirblog.org/the-sleeper-...

— Charles Gaba (@charlesgaba.com) 2025-05-23T20:08:36.569Z

THE PROVISION UNDER DISCUSSION

[Jspur]

1. This is terrible I

have used ACA when I lost my job a few times. The subsidies made it a much better option than going with COBRA. We are pretty much going back to the crappy system we had before ACA with this bill.

[MayReasonRule]

3. I And My Honey Are Partners In Our LLC -- The Marketplace Is How We Barely Afford Our Healthcare

Time will tell what happens.

We'll fight to our last breaths.

[Jspur]

4. I definitely understand and I'm concerned for some family members

who are self-employed and rely heavily on ACA for health insurance coverage. Heck eventually I want to get out of this rat race game and be self-employed. I'm currently doing side hustles, and I hope in 5 years to get to the point where the income I generate from them is good enough to quit my job, but I also need to get health insurance which is where the ACA comes into play.

[MayReasonRule]

5. We're In That Mid Range Of Incomes Where We Qualify For ACA And Private Insurance Would Take 50-75% Of Our Earnings

See what happens.

We won't go down without a fight.

[LauraInLA]

2. Kick! And thanks!