Marketplace Coverage: Tracking State-Specific Estimates of the Impacts of Proposed Federal Changes
Andrea Stewart and Emily Zylla, SHADAC
National and state discussions about the budget reconciliation bill (H.R. 1), signed into law on July 4, 2025, have largely centered on how federal policy changes and funding cuts might affect Medicaid and its enrollees. However, these changes and funding cuts will also impact another critical source of health coverage for over 24 million people in the Affordable Care Act Marketplaces, seven million of whom are enrolled through State-Based Marketplaces (SBMs). Several of the states that operate their own Marketplace released estimates of the potential impacts of these changes.
Twenty-three states, including the District of Columbia, operate SBMs or SBMs using the federal platform where the state (or a combination of the state and the federal government) is responsible for performing all Marketplace functions of the individual market–including applications, eligibility determinations, and enrollment. The federal policy changes included in the budget reconciliation bill, as well as the recently finalized 2025 Marketplace Integrity and Affordability Rule, will significantly impact many essential SBM functions and result in significant coverage losses. SBMs face challenges due to both reductions in federal funding and rule changes that would limit states’ flexibility to tailor Marketplace conditions to the needs of their residents. At the same time, the scheduled expiration of the enhanced premium tax credits (ePTCs) at the end of 2025 will lead to premium increases for enrollees causing many to forgo health coverage.
As the federal policy bills were being considered, SHADAC tracked states’ estimates of the impacts of the federal policy changes and the expiration of the ePTCs on SBM consumers (see below).
As detailed in the table and map above, state estimates varied significantly in both detail and scope. Some states, like California and Massachusetts, issued broad press releases highlighting overall impacts. Others, such as Pennsylvania, provided detailed analyses, including projected premium increases by income level, geographic region, and congressional districts. Maine paired its financial and coverage impact estimates with qualitative stories that illustrate how ePTCs impact residents’ lives.
The estimates collected here illustrate how states worked to assess the likely effects of major federal changes to their State-Based Marketplaces. With the legislation now finalized, we do not expect to add further updates to this resource. Should new data or analyses surface related to implementation, or particular aspects of the law, we will return to this topic as needed.