Affordable Care Act

Bipartisan Senate talks to revive expired enhanced ACA premium tax credits — centered on a two‑year stopgap with income caps, anti‑fraud guardrails and a year‑two HSA option led by senators including Susan Collins and Bernie Moreno — are imperiled by a dispute over whether and how to limit abortion coverage in marketplace plans, a core sticking point Republicans press and Democrats oppose. At the same time, negotiators are moving forward with a separate bipartisan package to reform PBM compensation in Medicare Part D, require unique identifiers for hospital outpatient departments to curb overbilling, and extend community health‑center and telehealth flexibilities — deliberately excluding an ACA subsidy extension.

President Trump’s "Great Healthcare Plan" is a high‑level four‑pillar framework — drug pricing, insurance reforms, price transparency and fraud protections — that the White House says would redirect federal payments “directly to you,” potentially by routing funds into health savings accounts (HSAs), but it provides no legislative text or operational details. Experts and Democrats warn it does not address the lapse of enhanced ACA premium subsidies and could leave lower‑income and ACA enrollees worse off, since HSAs skew to higher‑income users and the approach could encourage non‑comprehensive coverage that undermines ACA protections.