Senate Bill Proposes Major ACA Subsidy Extension and Program Integrity Rollbacks

The Restoring Patient Protections and Affordability Act, introduced by Senators Lisa Blunt Rochester and Ron Wyden, aims to extend the enhanced Affordable Care Act (ACA) subsidies through 2028 while reversing recent cost-saving measures. These enhanced subsidies, originally available from 2021 through 2025, cover the full cost of a benchmark silver plan for those below 150% of the federal poverty level (FPL) and cap premiums for those up to 400% FPL at 8.5% of income. The bill proposes to continue these subsidies in full without imposing the anti-fraud and program integrity policies enacted under recent rulemakings, thereby increasing federal deficits significantly. Fiscal analyses estimate this legislation would add approximately $350 billion to the national debt over the next decade, including interest, with costs potentially rising to $635 billion if the subsidies were made permanent. The increased costs stem not only from the extension of subsidies but also from repealing program integrity measures designed to mitigate waste, fraud, and abuse in ACA marketplace enrollment, such as income verification and limitation of subsidies during special enrollment periods. The bill would also undo provisions from the Trump Administration's Marketplace Integrity and Affordability Rule, including the allowance for lower actuarial value plans and changes to premium subsidy calculations. Additional provisions include extending the ACA open enrollment period, restoring navigator program funding, and creating new special enrollment periods. However, the legislation does not present any cost offsets or measures to contain subsidy expenditures. The proposed changes could reduce the number of uninsured Americans by 5 to 6 million upon full implementation, though coverage gains may include individuals who might not qualify under current program integrity standards. The Government Accountability Office has identified vulnerabilities to enrollment fraud within ACA exchanges, highlighting risks associated with relaxing verification requirements. Given the substantial fiscal impact and potential program integrity challenges, policymakers are advised to consider approaches that enhance subsidy cost-effectiveness, strengthen anti-fraud safeguards, and incorporate budgetary offsets. Options exist for bipartisan reforms to improve the sustainability and oversight of ACA subsidies while managing federal deficits. This legislation marks a significant development in the ongoing policy debate over affordability and access under the ACA, with important implications for insurers, regulators, and the insured population alike.