Football and Healthcare Headlines: What the “One Big Beautiful Bill” Means for ACA Enrolment and Costs

A major policy change with wide reach

Football news often sits alongside broader national stories that affect supporters and communities beyond the pitch. One of those developments is the GOP’s recently passed “One Big Beautiful Bill,” which introduces significant changes to federally subsidised and private health insurance programs. The provisions are intended to help pay for other tax and spending measures in the bill, but they come with a cost: the Congressional Budget Office (CBO) estimates the bill will cause 10.9 million people to lose health insurance by 2034.

Much of the projected coverage loss is linked to steep Medicaid cuts. However, the bill also significantly affects people who get health insurance through the health insurance marketplaces, also known as Obamacare. For many households, marketplace coverage is the route to staying insured, especially when budgets are tight and costs are rising elsewhere.

Annual verification becomes central to keeping subsidies

One of the biggest changes concerns premium tax credits, the federal subsidies that help reduce monthly insurance costs for many people enrolled in marketplace plans. Beginning Dec. 31, 2027, anyone who wants a federal subsidy in the form of a premium tax credit will need to verify eligibility every year.

That verification requires providing information about:

• Income
• Family size
• Immigration status
• Health coverage
• Place of residence

The vast majority of ACA enrollees are likely to be affected by this shift. In 2024, 93% of marketplace enrollees received tax credits. In practical terms, the annual verification requirement effectively does away with automatic re-enrolment for most people. Instead of being carried forward into the next year’s plan with minimal action, many will need to reapply every year to keep financial help in place.

Tighter restrictions on who gets help

The bill also tightens restrictions to limit subsidies even further for certain groups of people. While the specific groups are not detailed here, the direction of travel is clear: fewer people may qualify for the same level of assistance, and more applicants may face additional hurdles when trying to confirm eligibility.

These changes matter because subsidies are a key reason marketplace coverage is affordable for many households. If fewer people qualify—or if qualifying becomes more difficult—some may find themselves priced out of coverage.

The end of enhanced premium tax credits

Another notable element is what the bill does not do. It fails to extend the COVID-era enhanced premium tax credits, which are set to expire at the end of this year. The move is projected to have a significant impact: an estimated 4.2 million people are expected to lose coverage through 2034 because it becomes unaffordable.

In other words, even before accounting for new paperwork requirements and tighter restrictions, the affordability baseline could shift for millions of people who currently rely on enhanced support to keep monthly premiums within reach.

A shorter enrolment window adds pressure

Outside the bill itself, a provision in the government’s new Program Integrity Rule will shorten the annual enrolment period for ACA plans. Instead of two-and-a-half months, people will have a six-week sign-up window.

Shortening the enrolment period can compress decision-making into a smaller timeframe. For households juggling work, family responsibilities, and other commitments, a narrower window can increase the risk of missing deadlines—particularly when combined with the bill’s move away from automatic re-enrolment for most subsidy recipients.

Ripple effects: fewer enrollees, higher premiums

Experts expect these changes to echo across the marketplace. Allison K. Hoffman, professor of medical ethics & health policy at University of Pennsylvania Carey Law School, said: “People will lose insurance through ACA marketplace plans because of increased enrollment hurdles and an end to enhanced federal subsidies.”

As people drop out, the pool of customers—and the funds insurers can rely on to cover claims—will fall. The likely consequence is that insurers raise premiums for people who do not leave the marketplace. That dynamic can create a difficult cycle: higher premiums can make coverage harder to afford, which may push more people out, further shrinking the pool.

A bright spot for some: HSAs for Bronze and Catastrophic plans

Not every change is framed as a loss. There is a bright spot for people who usually enrol in low-coverage plans. The bill eliminates certain rules and language around what constitutes a high-deductible health plan (HDHP). As a result, Bronze and Catastrophic plan holders would be allowed to open health savings accounts (HSAs).

This could help relatively healthy people who do not need much coverage to pay for care with pre-tax money. For those who choose lower-coverage options and want a way to set aside funds for medical expenses, HSAs may offer a new tool—though the broader marketplace effects described above could still shape overall affordability.

Key takeaways for people on marketplace plans

While individual situations vary, the changes described point to several broad themes for marketplace enrollees:

• Expect more paperwork: Annual eligibility verification for premium tax credits would become a standard requirement for most people seeking subsidies.
• Plan for re-enrolment: Automatic re-enrolment would largely end for subsidy recipients, increasing the need to reapply each year.
• Watch affordability shifts: The expiration of enhanced premium tax credits is expected to make coverage unaffordable for some, contributing to projected coverage losses.
• Mind the calendar: A six-week enrolment period would replace the previous two-and-a-half-month window, leaving less time to compare options and submit information.
• HSAs may become available for more low-coverage plans: Bronze and Catastrophic plan holders could be newly able to open HSAs due to changes in HDHP-related rules.

Why this matters beyond policy

These developments are not just technical adjustments. The CBO’s estimate of 10.9 million more uninsured people by 2034 underscores the scale of the potential impact. With increased enrolment hurdles, the end of enhanced subsidies, and a shorter sign-up window, many people who currently rely on marketplace coverage may face new barriers to staying insured. At the same time, the possibility of HSAs for some lower-coverage plans introduces one area where certain enrollees may gain an additional option for managing out-of-pocket costs.

There are several steps people can take to maintain health insurance and be able to afford care, but the headline message is that the marketplace environment could become more demanding—both in timing and in documentation—while also becoming more expensive for those who remain if premiums rise as enrolment falls.