ACA Updates in 2025
The Affordable Care Act (ACA) continues to evolve in 2025, with significant updates impacting millions of Americans. Here's a concise overview of the key changes:
Supreme Court Upholds Preventive Care Mandate
In a pivotal decision, the U.S. Supreme Court appears poised to uphold the ACA's requirement for insurers to provide no-cost preventive services, such as cancer screenings and HIV prevention drugs. The Court expressed skepticism toward challenges questioning the constitutionality of the U.S. Preventive Services Task Force's role in determining covered services. A final ruling is expected by June 2025, potentially preserving access to essential preventive care for approximately 150 million Americans .
Record Enrollment and Enhanced Subsidies
The 2025 open enrollment period set a new record, with nearly 24 million Americans signing up for ACA Marketplace coverage. This surge is attributed to extended federal subsidies from the American Rescue Plan and the Inflation Reduction Act, which continue through 2025. These subsidies have significantly reduced premiums, with four out of five enrollees paying $10 or less monthly .
State-Level Innovations and Insurer Changes
Several states have implemented notable changes:
California: Expanded its program to eliminate deductibles and reduce out-of-pocket costs for all Covered California applicants.
New Mexico: Enhanced its State Out-of-Pocket Assistance (SOPA) benefits, offering plans with 90% actuarial value to enrollees with household incomes up to 400% of the federal poverty level.
Georgia: Transitioned to a state-run Marketplace platform, Georgia Access, for the 2025 coverage year.
Additionally, insurer participation has shifted, with new entries and exits across at least 19 states, affecting plan options and benchmark premiums .
Regulatory and Employer Reporting Updates
The ACA affordability threshold for employer-sponsored coverage has increased to 9.02% of an employee's household income in 2025, up from 8.39% in 2024 . Employers must ensure their health plans meet this criterion to avoid penalties.
Regarding reporting requirements, employers are now only required to provide Form 1095-C to employees upon request, simplifying the administrative process. Employers must notify employees of their right to request these forms and provide them within 30 days of the request or by January 31 of the following year, whichever is later .
Looking Ahead
While 2025 brings positive developments, the future of enhanced subsidies remains uncertain. The Congressional Budget Office projects that if these subsidies expire at the end of 2025, approximately 2.2 million people could lose health insurance in 2026, with premiums increasing by an average of 4.3% . Advocates are urging Congress to make these subsidies permanent to maintain affordability and coverage gains.
Staying informed about these changes is crucial for consumers and employers alike. As the ACA continues to adapt, understanding its evolving landscape will help ensure access to affordable, quality health care.
