Credit: ALM
Budget-cutters at the U.S. Department of Health and Human Services have dropped another hint that the Affordable Care Act public exchange system will continue to exist in 2026.
The administration of President Donald Trump may not like ACA or HealthCare.gov, but a 2026 budget proposal outline obtained by Inside Medicine and the Washington Post indicates that HealthCare.gov could operate as a somewhat smaller, self-financing program.
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Managers of HealthCare.gov pay for its operations by charging the health insurers that sell coverage through the system a user fee.
A 2026 budget proposal outline lets HHS use HealthCare.gov program revenue to fund HealthCare.gov activities but implies that some of the revenue could be used to pay for other HHS activities.
The HealthCare.gov user fees would be available for any other federal administrative expenses the HHS secretary incurred for "activities related to the exchange program, in addition to any other purposes authorized by law," according to the outline.
The backdrop: The members of Congress who drafted the Affordable Care Act created the public exchange system to serve as a web-based supermarket for commercial health insurance, in an effort to encourage relatively young, healthy people to pay for coverage, improve the overall health of the commercial health insurance risk pool and keep commercial health insurance alive.
HHS is the parent of the Centers for Medicare and Medicaid Services, the federal agency that runs HealthCare.gov and oversees the state-based ACA public exchange programs operated by states like California and Idaho.
HHS streamlining: HHS recently began the process of eliminating 20,000 of its 82,000 full-time positions, and CMS eliminated about 300 of its 10,000 positions, according to HHS.
HHS officials say they hope to cut costs, eliminate duplicate operations and make the remaining operations more efficient.
HealthCare.gov expectations: CMS gave an earlier indication that the administration of President Donald Trump would let the ACA public exchange system survive in March, when it released draft public exchange "market integrity" regulations.
Related: ACA changes could impact employer plans, individual coverage reimbursements
The draft regulations could require enrollees to pay at least $5 for coverage per month and require exchanges to verify more of the coverage applications submitted by people who apply outside of the standard annual enrollment period.
Officials called for the annual enrollment period to run from Nov. 1 through Dec. 15 in all states.
Today, the public exchange enrollment period starts Nov. 1 in most states but ends at different times.
Strong ACA supporters have interpreted the draft regulations as a Trump administration attempt to reduce ACA exchange plan enrollment and smother the exchange program.
Some agents and brokers have argued that efforts to keep applicants honest could help increase the stability of the exchange system in the long run, by decreasing the risk that people will pay exchange plan premiums only when they know they will have high medical bills.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
