No, there was no single new health insurance law replacing Obamacare in 2025 that would cover medically necessary care at a lower cost; instead, the ACA (Affordable Care Act) remained in place, but with significant cost changes due to factors like the expiration of enhanced premium tax credits. Beginning in 2026, these enhanced credits were set to expire, potentially leading to a more than 75% average increase in out-of-pocket premiums for many marketplace enrollees.
Continued ACA structure: The ACA, or Obamacare, was not replaced by a new system in 2025. It remained the framework for the health insurance marketplace.
Premium increases: Due to the expiration of enhanced premium tax credits, many people who buy insurance on the ACA marketplaces faced significantly higher premiums starting in 2026, with some analysis suggesting an average increase of over 75% for out-of-pocket costs.
Factors driving costs: Premium increases are attributed to factors like the rising cost of healthcare services, increased utilization of high-priced drugs, and general inflation.
Potential impact: The increased costs could lead to healthier enrollees dropping coverage, which in turn can drive up underlying premiums for those who remain.
Other changes: Other changes in 2025 included a new rule that prevents people with DACA from enrolling in ACA marketplace coverage in some states and changes to Medicaid eligibility redeterminations, which are expected to cause some people to lose coverage.
Whether the Affordable Care Act (ACA) could be replaced by a new system in 2025 that covers medically necessary care at a lower cost is a highly debated political and legislative issue. While new federal policies are being pursued in the new administration, any complete replacement of the ACA would require congressional action.
Legislative actions taken in 2025
Following the 2024 election, the Trump administration has taken a number of steps that will reshape the ACA, particularly for 2026 coverage. These changes have been pursued through regulatory changes and the budget reconciliation process. They include:
Expiration of Enhanced Premium Tax Credits: The enhanced ACA premium tax credits, which were extended through 2025 by the Inflation Reduction Act, will expire at the end of the year unless Congress acts. This is projected to cause millions to lose coverage and increase costs substantially for many more.
Regulatory Changes: Through a series of regulatory actions, the administration has made it harder for people to access and enroll in
Marketplace plans. This includes eliminating special enrollment periods for low-income individuals and adding more red tape for applicants.
Budget
Reconciliation Bill: The passage of the "One Big Beautiful Bill
Act" (H.R. 1) in July 2025 made numerous changes to the ACA, including
provisions that could lead to significant reductions in Medicaid
spending.
Projected impacts on cost and coverage for 2026
The outcome of these measures is projected to increase costs and reduce coverage for millions of Americans, according to analyses from organizations like the Congressional Budget Office and the Kaiser Family Foundation (KFF).
Without congressional action to extend subsidies, out-of-pocket premium payments are expected to more than double for many enrollees.
The CBO projects that, when combined, the changes enacted in 2025 could lead to 16 million more uninsured people by 2034.
Possible alternative coverage options for 2026
In 2025, several health insurance alternatives exist outside of the ACA's framework, though they generally offer less comprehensive and less reliable coverage. With the projected increase in costs and erosion of ACA protections for 2026, experts anticipate more people will turn to these alternatives.
Short-Term Medical Insurance (STM): These temporary plans offer low premiums but are not regulated by the ACA. They can deny coverage based on pre-existing conditions and impose limits on covered services.
Health Care Sharing Ministries (HCSMs): These are faith-based organizations where members share medical expenses. HCSMs are not insurance, offer no guarantees of payment, and often have religious requirements for membership.
Fixed Indemnity Plans: These plans pay a fixed dollar amount for specific services, regardless of the actual cost. They are not designed for major medical events and can leave patients with large out-of-pocket bills.
A note on congressional hurdles
Historically, efforts to fully repeal and replace the ACA have faced significant obstacles in Congress. Even with a unified government, passing comprehensive, lower-cost legislation to replace the ACA is extremely difficult due to the complexities of the U.S. healthcare system and deep political divisions. As seen in 2017, a complete replacement plan can fail to gain enough support even within the same party.
Norb Leahy, Dunwoody GA Tea Party Leader
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