By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.5
Close the ACA Marketplaces
End of Year 3 · CMS CCIIO; state exchangesDiscuss this step
Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.
| What | Today | Change | Trade-off |
|---|---|---|---|
| ACA Marketplaces (HealthCare.gov and state exchanges) endsEnd of Year 3 Federal programs | 21.1M enrollees (2024) with premium tax credits; annual open enrollment; narrow networks. | Close at end of Year 3; premium tax credits ($116.6B) redirected. | Ends subsidy cliffs and churn; Marketplace staff and navigator jobs end. |
| Navigator and enrollment-assistance grants replacedYear 4 Federal programs | Fund community groups to help people enroll in coverage. | End; resources shift to UHA patient advocacy and outreach for hard-to-reach groups. | Less need for enrollment help; community organizations lose a funding stream. |
| IRC §36B premium tax credits endsYear 4 Federal tax code | $116.6B in 2024 for Marketplace coverage. | Repealed after Year 3; money redirected to UHP. | Ends complex reconciliation and repayment at tax time. |
| ACA cost-sharing reductions & silver loading endsEnd of Year 3 Federal programs | Lower deductibles for low-income Marketplace enrollees; insurers load the cost into silver premiums. | End with the Marketplaces; no cost sharing exists to reduce. | Ends a convoluted subsidy mechanism. |