Second Verse, Similar because the First: Senate Reconciliation Language Failes to Repair Paperwork Burdens, Different Boundaries to Market Protection

By Karen Davenport, Stacey Pogue, and Sabrina Corlette

With the passage of H.R.1, the Home of Representatives’ model of the finances reconciliation invoice that can advance President Trump’s home coverage agenda—particularly, extending tax cuts for rich people and companies whereas making huge cuts to meals help, well being protection and entry, and inexperienced vitality investments—all eyes turned to the Senate. In mid-June, the Senate Finance and Well being, Training, Labor, and Pensions Committees launched legislative language that will likely be basis for Market modifications within the Senate’s finances invoice.  Whereas the Senate language purports to ease the enrollment obstacles to Market protection which can be an indicator of the Home invoice, it’s actually a case of “second verse, identical as the primary.” The Senate language would nonetheless go away Market enrollees weak to surprising premium payments and prone to dropping their medical insurance protection. 

Recapping the Home Invoice: Protection Losses Pushed by Enrollment Boundaries

The Home-passed invoice will reverse the protection and entry features made doable by the Inexpensive Care Act medical insurance Marketplaces by counting on a number of key methods. First, it’s going to enhance Market enrollees’ prices for holding medical insurance protection. Second, it’s going to create new paperwork obstacles to enrollment, thus making certain that fewer eligible particular person and households are capable of enroll in medical insurance. And third, it prohibits sure folks from enrolling in Market protection altogether. All in all, the Congressional Funds Workplace estimates that roughly 4 million folks will lose protection as a direct results of the provisions within the Home-passed invoice. 

CHIR has beforehand revealed on the general impacts of the Home-passed invoice, taken a deep-dive into a few of its most problematic provisions, examined which enrollees might be misplaced in a paperwork thicket, thought-about how the invoice hamstrings state-based Marketplaces (SBMs), and recognized misplaced alternatives to discourage precise, fairly than imagined, enrollment fraud.

Heralded Fixes Fail to Stem Doubtless Protection Losses

The Senate Finance Committee modified the Home language to attempt to tackle acknowledged issues with the Home invoice. For instance, the Finance Committee creates new administrative discretion for the Treasury Secretary to make sure that individuals who expertise a change in household measurement in the course of the 12 months—reminiscent of having a child—don’t lose their premium subsidies and, by extension, their medical insurance. Ought to the Treasury Secretary train this discretion, this provision might tackle an essential protection barrier within the Home invoice. Alternatively, “lacking” provisions within the Senate language, in comparison with H.R.1, are additionally discovered within the “Market Integrity” rule the Facilities for Medicare & Medicaid Companies (CMS) proposed on March 19, 2025. In some instances, these provisions would take impact even earlier beneath the proposed rule. These enrollment obstacles—reminiscent of shortening the length of annual Market Open Enrollment—might nonetheless be added to the reconciliation invoice earlier than it reaches the Senate flooring, and the regulatory proposal will presumably be finalized quickly. Whether or not these provisions are applied by way of regulation or a statute, customers will encounter the identical crimson tape and better prices.

Little Daylight Between Home and Senate Laws

Most significantly, the general strategy of the Senate committees’ reconciliation proposals intently mirror the Home reconciliation invoice. As seen within the desk under, each efforts search to cut back Market enrollment by creating new and surprising premium prices, elevating new obstacles to enrolling in and holding protection, and blocking sure people from enrolling in Market protection.

Enrollment Boundaries to Market Protection in Reconciliation Laws

Takeaway

Like its Home companion, the Senate reconciliation invoice threatens Market enrollees’ reasonably priced well being protection and the entry to care that medical insurance protection makes doable. Underneath each proposals, Market enrollees will face vital new prices and obstacles to protection.