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How Americans’ Financial Health Is Faring In The “K-Shaped” Economy
Hey all, Jason here. Money20/20 is still two weeks away, but I’ve already started packing (not procrastinating for once!). My calendar is already filling up with various sessions I want to catch, meetings, and of course happy hours, dinners, and other side events. If you’ll be in Vegas and want to catch up, let me know by replying to this email, and we can try to find a time amidst the chaos of the Venetian. A big if not totally unexpected piece of news dropped on Friday: the Independent Community Bankers of America, a trade group that represents smaller U.S. banks, filed a lawsuit against the OCC and Comptroller Jonathan Gould, arguing that the regulator’s move to grant trust bank charters to firms seeking to use them to conduct substantial non-fiduciary activities exceeds the authorities granted to the OCC by Congress. I haven’t had time to fully digest the legal filing or speak to folks in my network about it, but you can expect to see coverage and analysis on it in next week’s newsletter. Subscribe or Support by Upgrading The NerdCon agenda just dropped. It’s stacked. Partner content: Nubank built an AI-first bank. Chime built its own banking core. Figure and Valon are rebuilding the mortgage stack. At NerdCon, you’ll hear from the people behind those bets: what they chose, what they learned, and what they’re still figuring out. The agenda is live, with leaders from Nubank, Chime, OpenAI, Remitly, Mercury, Figure, Valon and more. Follow the mainstage conversations, bring the problem your team is wrestling with to a hands-on workshop, or pull up a chair at a roundtable. Pick your quests. Meet us in San Diego, November 18–20. Fintech Business Weekly readers save 20% with code FBW20. Explore the Agenda Things To Know & Other Good Reads Federal Reserve Board finalizes changes to enhance the transparency and public accountability of its stress test and reduce volatility in its stress test-related capital requirements (Federal Reserve Board of Governors) FDIC Announces Conclusion of Independent Monitorship (FDIC) Modernizing Financial Regulation: Initial Observations from eSLR (Fed Vice Chair for Supervision Michelle Bowman) The Data Version of Godzilla versus Kong: FRED Takes on AI (Fed Governor Christopher Waller) Financing the AI buildout (Brookings) Q3’26: Rules for Banks but Not for Crypto (Fintech Takes Banking) The Inevitability of Local Stablecoins (Lombard Notes) Delusions of AI Governance: The Human-in-the-Loop Comfort Blanket (Fintech Snark Tank) Stripe agrees to acquire Parafin to expand revenue opportunities for platforms and help small businesses grow (Stripe) Listen: Fighting Fraud in the Age of AI, with SEON’s Tamas Kadar (Fintech Business Weekly) How Americans’ Financial Health Is Faring In The “K-Shaped” Economy If there is one overarching theme across the economy and politics in the U.S. at the moment, it’s “affordability.” The term is vague enough to encompass a panoply of factors shaping Americans’ day-to-day lives: rising costs for the hallmarks of being “middle class,” including healthcare, housing, childcare, and education, inflation and rising interest rates, and a job market with the specter of AI hovering over it. At the same time, policy shifts under the Trump administration have resulted in reduced subsidies to those who get health insurance under the Affordable Care Act and new restrictions on qualifying for Medicaid and SNAP, the impacts of which have yet to be fully felt. These factors are contributing to declining consumer confidence and general dissatisfaction with the economy, despite continuing GDP growth and stock market records. This divergence is encapsulated in the idea of the “K-shaped” economy, in which a small proportion of Americans have seen their wealth balloon, while the majority of American households struggle to preserve the lifestyle they have. Perhaps the greatest determinant of which branch of the “K” a household is on is whether their wealth and income are primarily derived from employment vs. from assets. Nearly two decades of low interest rates and, more recently, elevated rates of inflation have benefited asset owners, while those whose income is primarily or solely derived from labor have largely seen real purchasing power stagnate or decline. This is reflected in recent Bureau of Labor Statistics data showing that labor share of U.S. GDP — the fraction of economic output that accrues to workers as compensation in exchange for their labor — dropped to just 52.8% in Q2 2026, the lowest since the BLS began keeping records. In 1947, approximately 2/3rds of economic output accrued to workers; even as recently as 2001, labor’s share of GDP was 64.1%. Against this backdrop, we’ve seen the rise of more credit and credit-like products: cash advance apps, “no-fee” overdraft, earned wage access, and buy now pay later, which are often used as small-dollar short-term borrowing mechanisms to meet immediate consumption needs or pay other bills (eg utilities, cell phone, other debt payments). With the markers of a middle class existence and, increasingly, basic financial stability seemingly out of reach for many, it should be no surprise there’s been an increase in “financial nihilism,” something industry peers like Alex Johnson and Frank Rotman have discussed and analyzed the roots of. The explosion of gambling and gambling-adjacent products and services — often marketed under the guise of being an “investment” — is inextricably intertwined with the rise of financial nihilism. Crypto, sports betting, and, more recently, prediction markets offer an escape or even hope of sorts, like a contemporary, digital version of a scratch-off lottery ticket, while leaving the overwhelming number of people who use such products worse off. Share of Households That Are Financially “Vulnerable” Ticks Up The Financial Health Network’s 2026 Financial Health Pulse® report adds context on how American households are faring. (I linked to this report in last week’s newsletter, but wanted to take time to further unpack the data in the report this week.) The Financial Health Network publishes the report annually, providing insight into how Americans’ financial circumstances are changing over time. The 2026 report is derived from a survey fielded in April and May 2026. The report leverages survey responses to assess indicators of financial health across spending, saving, borrowing, and planning/protecting and to determine a zero to 100 “FinHealth” score. Those with scores between 0 and 39 are considered “Financially Vulnerable,” consumers with scores ranging between 40 and 79 are defined as “Financially Coping,” and those with scores of 80 to 100 are “Financially Healthy.” The report found that moderate improvements in 2025 were reversed, with the share of respondents considered financially “vulnerable” rebounding to 17%. The longitudinal data reflect the impact of pandemic-era programs, like expanded unemployment, cash stimulus payments, and pauses of federal student loan payments. The positive impacts of those programs, as reflected in the Financial Health Pulse reports, had largely disappeared by 2023. While pandemic-era inflation — to be fair, in part caused by the various support and stimulus measures — had come down from as high as 9% in 2022, it has rebounded since the start of Trump’s second term, with tariffs and energy market disruptions owing to the war in Iran pushing prices back up. Specific indicators in the survey that deteriorated from 2025 to 2026 include the share of respondents spending less than their income over the past 12 months, the share paying all bills on time over the past 12 months, the share that have a manageable amount or no debt, the share that are “moderately” or “very” confident their insurance is adequate to cover them in an emergency, and the share that “somewhat” or “strongly” agree that their household plans ahead financially. Unsurprisingly, lower- and moderate-income households are more likely to struggle to pay their bills on time and have any funds leftover to save. The share of low-income households whose income exceeded their spending dropped from 35% in 2025 to 31% in 2026, while the share of upper-income households whose income exceeded expenses remained unchanged at 63%. Households with student loans or revolving credit card debt reported having “a bit more” or “far more” debt than was manageable at rates far higher than those not carrying these types of debts. The share of those with student loan debt indicating their debt load was too high to manage increased from 50% in 2025 to 55% in 2026, while the share of those with revolving credit card debt saying the same ticked up from 51% in 2025 to 54% in 2026. Households that had student loans were markedly more likely to be financially “coping” or “vulnerable” vs. those without student loans. In 2026, 27% of households with student loans were considered financially vulnerable, a jump of 6% points vs. 2025. Households without student loans saw just a 1% point increase (not statistically significant) in those considered financially vulnerable. Households’ perception of the affordability of categories of goods and services paints a stark picture, with less than one-fourth considering higher education affordable, about a third deeming childcare affordable, and less than half viewing healthcare as affordable. Fintech Business Weekly is made possible by the generous support of paying subscribers — bringing you independent analysis of banking, fintech, and crypto without fear or favor. You can support my work by becoming a paying subscriber if you aren’t already. Paying subscribers enjoy: access to the entire archive of nearly six years of newsletters extended versions of the weekly newsletter, with additional content and analysis and (for founding member tier) quarterly personal 1:1 fintech Q&A / strategy calls with me, tapping into my unparalleled knowledge of the intersection of banking and fintech and experience working in the sector, including helping to launch Goldman Sachs’ retail bank Marcus Support Fintech Business Weekly You can also support Fintech Business Weekly by sponsoring a newsletter or podcast, putting you in front of 93,000+ of the most influential decision makers in banking, fintech, and crypto. Learn more about sponsor opportunities or request a media kit by dropping me an email. Democratic Senate Report Highlights How Iran Uses Tether to Evade U.S. Sanctions Iran uses stablecoins, specifically Tether, to evade sanctions, fund regional proxies, and to purchase military drones, a report released last week by the Senate Permanent Subcommittee on Investigations says. The report was authored by committee ranking member Senator Richard Blumenthal (D-CT) and the minority staff. Crypto and stablecoin proponents will often push back on criticism that criminals make use of these assets by arguing that, on an absolute dollar basis, far more illicit funds flow through traditional banking systems and payment rails than via crypto and stablecoins. And while that is likely true, it elides the reality presented in news story after news story: whether state actors — Russia, Iran, North Korea — or criminal groups, those looking to engage in illicit transactions increasingly favor stablecoins and, specifically, Tether (USDT). The report from the Senate Permanent Subcommittee on Investigations released last week adds context to how Iran uses Tether has a lynchpin in its shadow banking system. The report analyzed 846 wallets that have been sanctioned or targeted for seizure, finding that 84% of them transacted exclusively or primarily in Tether. The ability to create near limitless, anonymous wallets and to move funds effectively instantaneously and irreversibly have made crypto a favored financial mechanism for bad actors. Stablecoins solved key drawbacks of bitcoin, namely, the original cryptocurrency’s highly volatile value in dollars. And while Tether (the company) has the technical ability to “freeze” or destroy funds, the company is often limited and reactive in its approach to doing so, the Senate report argues. Tether, which is nominally based in crypto-friendly El Salvador, “has stated that its compliance with OFAC sanctions is ‘voluntary’ and that it follows ‘OFAC guidelines,’” the Senate report says. Owing to these favorable attributes, Tether “became a primary cryptocurrency for Iran, Hamas, Hizballah, and the Houthis beginning in 2023 and has expanded in scale since,” according to the report. Tether’s role in Iran’s shadow banking system, the report says, is enhanced by crypto exchanges like Bybit, Kyrrex, OKX, Gate, and Binance, and through “over the counter” exchanges and hawala networks. The consequences of these financial flows aren’t hypothetical. The Senate report links Tether as a funds transfer mechanism to Iranian proxies in the region, including Hizballah, the Houthis, and Hamas. Tether has also been used to make payments to secure components necessary to manufacture drones, the report says. The report concludes by arguing that “[s]tablecoin issuers with a significant nexus to the United States, particularly those that offer dollar-denominated stablecoins, should be subject to American sanctions law rather than being allowed to hide behind foreign jurisdictions.” Stablecoin issuers like Tether must be held accountable for repeated failures to prevent illicit finance and sanctions violations by law enforcement, the Department of Justice, the Securities and Exchange Commission, and OFAC, the report argues. [Paying Subscriber Exclusive] OUSD Goes Live, Make Your Own Neobank, U.S. Sanctions Russia’s A7 Network As “Transnational Criminal Organization” OpenUSD, the stablecoin issued by the Open Standard consortium that includes Stripe, Visa, Mastercard, core providers, crypto firms, and numerous banks, went live last week. Social commerce platform Whop raised eyebrows in fintech by offering creators on its platform the ability to launch their own neobanks, which the company describes as “great businesses that are easy to run,” in just 15 minutes. And OFAC and FinCEN target Russia’s “shadow banking” A7 Network — more on these stories after the paywall.
Trump sends out $500 ACA refunds and a letter promoting his record
The rebate checks are headed to nearly 1 million people President Donald Trump says were overcharged under the Affordable Care Act.
Virginia Democrats warn more healthcare strains loom after November election
Christina Rivera kept her health insurance this year because she needed major back surgery. But maintaining coverage meant absorbing a monthly premium that rose from $235 in 2025 to $1,336 in 2026 — with a higher deductible. “That’s just not reasonable for anybody who is relying on the ACA for healthcare,” said Riviera, a Charlottesville-area resident and founder of the nonprofit Called to Justice. “I don’t have that sitting around. It’s not in the cushions of the couch.” Small nonprofits often depend on the Affordable Care Act marketplace because reasonably priced group coverage is out of reach, Rivera said. After enhanced federal premium tax credits expired last December, her insurance bill became another financial burden alongside groceries, gasoline and utilities.
CareSource, Molina to drop ACA Marketplace plans in Ohio in 2027
Dayton-based health insurer CareSource, along with another health insurer Molina Healthcare of Ohio, will not have plans offered through the Affordable Care Act Marketplace in Ohio in 2027.
The New Health Care Populism
Fear over rising costs is fueling bipartisan motivation to confront drug companies, insurers, and pharmacy benefit managers directly, with candidates on both sides racing to appear stronger on those areas than their opponents rather than litigating the Affordable Care Act. Republicans have been espe
Rogers Tries to Make El-Sayed’s Health Care Plan Scary
_Taylor, Michigan_HERE’S HOW YOU CAN TELL Mike Rogers is anxious to make up ground in the Michigan Senate race: He held a press conference on health care last weekend. Health care is usually a rough issue for Republicans, because voters associate the GOP with attacking cherished programs like Medicare and Medicaid that Democrats have historically supported. It’s a particularly difficult issue in this campaign, because a few months ago Donald Trump and the Republicans refused to extend temporary financial assistance in the Affordable Care Act. As a result of that decision, more than 20 million Americans faced higher insurance prices this year. That’s not a policy choice you want to be defending at a time when voters frequently cite the cost of health care as a top concern. Throw in the fact that Democratic nominee Abdul El-Sayed can draw on his credibility as a doctor and former public health director in Detroit, and it might seem like Rogers’s best bet would be to avoid health care altogether. But Rogers had his reasons to spotlight health care last Saturday. And they became apparent a few minutes before he spoke, when members of his campaign staff There’s a lot happening. Too much, some days. We can’t promise to have all the answers. But we can promise to keep asking the questions, following the facts, and figuring things out alongside people who care about where this country is headed. Read with us. Learn with us. And when it matters, stand with us. Join the side you’re already on. Join Bulwark+
Harrison: Will Mississippi politicians avoid blame for rising healthcare costs?
Nearly all of Mississippi’s congressional delegation voted against extending the enhanced tax credits or subsidies for the Affordable Care Act Marketplace insurance policies.
DC Health Link Not Impacted by Federal Health Insurance Cancellations
Earlier this week, the Trump Administration announced plans to remove more than 750,000 Americans from health insurance plans purchased through healthcare.gov, a marketplace established by the Affordable Care Act (ACA). The administration alleges that the removed individuals were fraudulently enrolled in the program. In the District of Columbia, the DC Health Benefit Exchange Authority (DCHBX) […]
HHS cancels health insurance of 760,000 individuals enrolled in healthcare.gov plans
The Department of Health and Human Services announced something it's never done before - canceled the health insurance of 760,000 individuals enrolled in plans in the Affordable Care Act marketplace.
Health insurance premiums to see 16% spike as PA insurance department release '27 rates
Pennsylvanians who buy health insurance through the Affordable Care Act marketplace will see a noticeable spike in their premiums, according to PID.
Double-digit increases await Pennsylvania Obamacare enrollees
For the second year in a row, Pennsylvanians with individual health insurance through the Affordable Care Act will see an average double-digit increase...
Healthcare affordability is shaping competitive races ahead of the midterm elections
Healthcare costs are rising at their fastest pace in decades, just as early voting begins in Virginia. KFF Health News' Julie Rovner says the moment echoes the run-up to the Affordable Care Act — and voters are taking notice.
2027 rates established for Del. Health Insurance Marketplace Coverage
What will be the cost of 2027 coverage under the Affordable Care Act?
Chaney: Mississippians deserve more affordable health insurance options
Over the past year, more than 200,000 Mississippians have left the Affordable Care Act marketplace as the cost of coverage has increased due to the expiration
Mike Chaney: Mississippians deserve more affordable health insurance options
Over the past year, more than 200,000 Mississippians have left the Affordable Care Act marketplace as the cost of coverage has increased due to the expiration of the Enhanced Premium Tax Credits at the end of 2025.
Healthcare saving hacks to consider before November's open enrollment
As insurance costs continue to rise, coupled with recent changes to the Affordable Care Act, some of the subsidies people count on have been rescinded. So how do you save money on healthcare?
Inside America's health insurance 'death spiral'
The Affordable Care Act is facing what policy experts call its most serious affordability crisis since it began widely offering coverage more than a decade ago
The U.S. Healthcare System is Already Mostly Socialized
Now that Abdul El-Sayed is the Democratic nominee for Michigan’s open Senate seat, the outcome of this crucial race will depend mainly on two things: Whether Republicans succeed in demonizing El-Sayed because he’s brown and a Muslim, and whether they succeed in demonizing him as a left-wing radical. I will defer for the now the question of whether bigotry will be effective this year, although I will address it another day. What I want to address instead is El-Sayed’s signature issue — healthcare. Yes, El-Sayed advocates Medicare for All, a position the usual suspects denounce as “socialism.” I will get to the politics of his stance soon. Today, however, I want to talk about the substance. We should be clear that El-Sayed doesn’t even call himself a socialist. On the contrary, he explicitly disavows the label, saying “I’m a capitalist who just knows about capitalism”. In fact, as I explained in a previous post, the policies that El-Sayed advocates qualify him as a social democrat, not a socialist. Still, El-Sayed advocates a system under which the government would pay almost all medical expenses. Isn’t that socialism? Well, if that is the criterion then much of U.S. healthcare is already socialist. In fact, the government’s role is so large that U.S. healthcare is better described as partially privatized socialism than as anything resembling a free market. Let’s start with the raw numbers on health insurance, which pays the bulk of Americans’ medical expenses. Americans receive health insurance either from private companies or from public programs, overwhelmingly Medicare and Medicaid. Here’s what the breakdown of coverage and spending between private and public looked like in 2024: While a majority of Americans with health insurance get it from private companies, well over 100 million of us are covered by government programs instead. And these government programs pay more total dollars for medical bills than the private insurers do. Why do government programs that cover a minority of the population account for a majority of health insurers’ outlays? Mainly because Medicare covers seniors, and we’re expensive. Also, while Medicaid covers many younger Americans, disabled and elderly beneficiaries account for most of its spending. Even by the raw numbers, then, U.S. health insurance looks as much public as private. But that understates the government’s role: Private health insurance in the U.S. is both highly regulated and heavily subsidized. This is obviously true for the insurance coverage purchased by tens of millions of Americans through the exchanges established by the Affordable Care Act. But employment-based health insurance, which covers 161 million Americans, is far more of a government creation than most people realize. For employment-based insurance exists largely because of huge implicit government subsidies that come with major strings attached. Here’s how that works. If your employer pays you $10,000, that’s taxable income. But if your employer pays $10,000 toward a company health insurance plan that meets certain criteria, it isn’t taxable. That’s a huge effective subsidy, running at more than $300 billion a year. Take that subsidy into account, along with the more than $100 billion per year spent subsidizing policies purchased under the ACA, as well as the outlays on Medicare and Medicaid, and net effect is that the government pays for more than two-thirds of Americans’ health insurance. Granted, there are strings attached. Roughly speaking, employment-based health plans can’t discriminate based on medical history — that is, they can’t deny coverage to employees with pre-existing conditions — and they also can’t offer the plans only to highly compensated employees — a health plan that is only for the C-suite is considered taxable income. So given the restrictions of the federal tax code, employer-based health insurance is a lot like Obamacare, which also prohibits discrimination based on medical history and provides subsidies to make insurance affordable to lower-paid workers. The fact is that virtually all of private healthcare insurance is already well under some form of government control through regulation and tax subsidies. How should we think about this system? First of all, is Medicare socialist? Don’t tell anyone, but the way Medicare operates — it covers every senior’s medical expenses, whatever they turn out to be, while being funded by taxes that depend on one’s income — could be summarized by the old Marxist slogan “From each according to his ability, to each according to his need.” And back in 1961, when Ronald Reagan was the face of a last-ditch effort by the American Medical Association to block the creation of Medicare, he denounced Medicare as “socialized medicine” and warned that it would destroy our freedom. In reality, American freedom survived until Jan. 20, 2025, while Medicare is immensely popular, with an 82 percent favorable rating in the most recent KFF survey. Medicaid, government health insurance for lower-income Americans, comes in at 73 percent. This is in sharp contrast to public views about private insurers, who are widely disliked if not hated and accused of denying essential care. Furthermore, if Medicare is socialism, then the whole U.S. health insurance system, with the government paying most of the bills and placing conditions on private insurers, is almost equally socialist. If you insist on calling any program the government pays for and regulates socialist, then U.S. healthcare would best be described as a partially privatized form of socialism. And one must ask, what is the point of the part that is privatized? Do private insurers add anything positive? Or are they simply parasites, skimming off money that could have been paying for care? The case for viewing insurers as parasites is strong. Many Medicare benefits are now delivered via Medicare Advantage, that is, plans paid for by the government but run through insurance companies. MedPAC, an independent advisory commission, estimates that last year Medicare Advantage plans were overpaid by $84 billion, thanks to practices such as “upcoding,” in which patients’ health problems are overstated to get larger sums from Medicare. Assessing the waste from employer-based insurance is harder, but most evidence suggests that private insurers have substantially higher administrative costs than Medicare does. Furthermore, the complexity of private insurance, with multiple payers all trying to deny care when they can, is a huge burden both on providers — doctors, nurses, and hospitals — and on patients. What do private insurers offer to compensate for these costs? One must go through intellectual contortions to avoid the conclusion that they are, in fact, parasites. Which brings me back to El-Sayed. In supporting Medicare for All, he’s basically calling for an end to the partial, parasitic privatization of a healthcare system that is already hugely dependent on public funding. When one looks at it that way, it’s not at all a radical proposal. Admittedly, the political lift requires overcoming the opposition to higher taxes to pay for Medicare for All. Political realism rather than economics was the reason I and many other progressives supported Obamacare, with all its complexities, rather than demanding an immediate move to Medicare for All. But the political calculus may very well have shifted since the 2000s, as Americans are fed up with a system of unaffordable premiums, rampant claim denials, and byzantine claim administration. Moreover, funding healthcare insurance through taxation would allow for a much more progressive distribution of the cost. That is, compared to the present system, middle-income households would pay less as high-income households would pay more. And the U.S. would stop wasting large sums on pointless administrative costs. So let’s be clear: El-Sayed’s healthcare platform is perfectly reasonable on the merits of cost, fairness and health efficacy. And with private insurers never more hated, while millions of Americans are losing their health insurance, 2026 may be its time. MUSICAL CODA
450,000 NYers just lost their health insurance: How one Syracuse caregiver is coping
Tyler Lyons' no-cost health insurance was a casualty of cuts to the Affordable Care Act.
These Arizona health insurance companies are seeking rate increases of more than 25%
Health insurance companies in the Affordable Care Act marketplace are seeking an average premium increase of 25% in Arizona for 2027.
Commentary: AI Could Help to Implement Health Policy
Artificial intelligence may enhance implementation of a new federal rule requiring aduts enrolled under the Affordable Care Act expansion of Medicaid eligibility to complete qualifying work hours or community engagement activities or meet exemption criteria to maintain coverage, according to a new commentary.
Costa Welcomes House Democratic Caucus Chair Pete Aguilar to Central Valley Health Care Roundtable
FRESNO, Calif. - This week, during Affordable Healthcare for Every American Week of Action, Congressman Jim Costa (CA-21) welcomed Congressman Pete Aguilar (CA-33), Chair of the House Democratic Caucus, to the Central Valley for a roundtable hosted by Community Health System to hear directly from local hospitals and health care leaders focused on the federal funding reductions under H.R.1, including changes to Medicaid and the Affordable Care Act, as well as the Administration's decision to withhold approximately $867.5 million in federal Medicaid funding from Califor
http://democrats-energycommerce.house.gov/media/press-releases/republican-health-care-cuts-continue-devastate-american-families
Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and House Energy and Commerce Committee Ranking Member Frank Pallone Jr., D-N.J., today released their latest report spotlighting the consequences of the Republican Big Ugly Betrayal, which slashed over $1 trillion from Medicaid and the Affordable Care Act in July 2025.
Affordable Care Act rates could increase again in Pennsylvania
People who buy their healthcare coverage in Pennsylvania through the Affordable Care Act are expected to see their premiums skyrocket.
Requested 2027 Affordable Care Act rate increases average 17.1% in Pennsylvania
Health insurers serving Pennsylvanians with coverage under the Affordable Care Act are proposing to increase premiums by an average of 17.1% for individuals...
Health insurance costs leave older Mississippians without care
Because insurers can charge people in their 60s premiums three times higher than those in their 20s, many older adults enrolled under the Affordable Care Act saw some of the steepest price increases this year without the income-based subsidies.
AHA responds to CMS on potential modifications to ACA’s Essential Health Benefits
The AHA July 15 responded to a request for information from the Centers for Medicare & Medicaid Services on the Affordable Care Act’s Essential Health Benefits framework, which creates the guardrails for defining comprehensive insurance coverage.
Soaring costs and end of tax credit leads 17,000 Minnesotans to drop MNSure health coverage
This year, 17,000 Minnesotans have dropped the health insurance they had purchased in the Affordable Care Act marketplace known as MNSure, as insurance premiums soar and a tax credit that many people use to help defray the cost of ACA insurance expired.
Pelosi, Rowe-Finkbeiner: We can fix health care, but Trump chooses Iran
Republicans triggered this health care crisis by slashing $1 trillion from Medicaid and failing to extend the Affordable Care Act premium tax credits.
Phil Scott issues executive order that would allow age-based health insurance premiums
The order directs the Department of Financial Regulation to explore alternative insurance options for small businesses, beyond the Affordable Care Act.
Storm warning for ACA shoppers: Double-digit premium hikes are coming
The 2027 outlook for the Affordable Care Act is severe.
Maryland health insurance rates could rise 13.7% in 2027 under proposal
BALTIMORE — Maryland residents who buy health insurance through the Affordable Care Act marketplace could see higher premiums next year, with insurers requesting an average rate increase of 13.7% for
Long-Awaited Rule Aims To Boost ACA Choices While Embracing Higher Deductibles
By Julie Appleby and KFF Health News HealthDay ReportersTUESDAY, June 16, 2026 (HealthDay News) — The Affordable Care Act (ACA) seems to always be in a policy tug-of-war as its backers and critics spar over how it should work and who can qualify for coverage. This year is no different, with the ...
CMS, HHS request information for potential modifications to ACA Essential Health Benefits
The Centers for Medicare & Medicaid Services and the Department of Health and Human Services issued a request for information (https://www.federalregister.gov/documents/2026/06/15/2026-11994/request-for-information-comprehensive-review-of-the-essential-health-benefits-framework-and-typical) June 12 seeking input on CMS’ review of the Affordable Care Act’s Essential Health Benefits framework and the requirement that the scope of EHBs is equal to the scope of benefits provided under a standard employer plan.
As Affordable Care Act premiums skyrocket, catastrophic coverage is having a moment
Jason Miller watched his monthly health insurance premiums quadruple to $374 from $80 for a silver-level plan when the Affordable Care Act’s enhanced...
New Federal Rule Makes Sweeping Changes to Health Insurance Marketplace Regulations
A new rule issued by the Centers for Medicare and Medicaid Services makes a long list of changes to the Affordable Care Act marketplaces that the agency says will lead to more plan choices and lower premiums for consumers.
Millions of Americans are losing their health insurance
The GOP’s Big, Beautiful Bill sought to roll back the Affordable Care Act. Now, the human costs are becoming clear.
Cheaper, Alternative Health Plans Are Having A Moment, But Critics Urge Caution
By Sarah Kwon and KFF Health News HealthDay ReportersWEDNESDAY, May 27, 2026 (HealthDay News) — When Melanie Miller saw that her health insurance premium payment was set to nearly triple to $914 a month this year, she stopped shopping on the Affordable Care Act (ACA) marketplace. The 59-year-old ...
Bonus 228: The $1.776B Political Question
Every so often a story comes along that is so brazen, so cleanly emblematic of the moment we are living through, that staying quiet about it feels like a kind of complicity unto itself. Monday’s announcement by the Department of Justice that the Acting Attorney General has unilaterally created a $1.776 billion “Anti-Weaponization Fund” to compensate so-called “victims of lawfare” is one of those stories. And the reason I want to write about it here, in a newsletter ostensibly devoted to the Supreme Court and the law and politics surrounding it, is that I’m increasingly worried that we’re asking the wrong institution to save us from one of the most offensive, alarming, and anti-constitutional things we’ve seen from any president in American history. As I explain below the fold, the Anti-Weaponization Fund is not principally a legal problem awaiting a judicial fix. It is a shockingly egregious political abuse—the President suing his own government, purporting to settle with himself, and routing nearly $2 billion from the Treasury to his own supporters as a not-so-subtle (and not-so-formal) reward, if not an incentive, for political violence. And the Constitution’s answer to political abuses of this kind and magnitude is a political remedy, not a legal one. In his majority opinion in NFIB v. Sebelius (the Affordable Care Act case from 2012), Chief Justice Roberts defended the Court’s endorsement of Congress’s power to adopt the individual mandate by noting that it is “not our job to protect the people from the consequences of their political choices.” As much of a judicial supremacist as I am, that sentiment is, for better or worse, an entirely correct (and, in the long term, normatively desirable) institutional assessment. One can believe in substantial judicial power without believing that literally every political dispute in our country can and should be resolved by unelected judges. The real upshot of this latest headline (among so, so many other similar headlines) is that it is past time to reinvigorate impeachment—not because conviction is realistic in this Senate, or even because impeachment itself is feasible in this House, but because forcing every member of Congress to vote on the record whether this brazen, corrosive, and affirmatively dangerous corruption is impeachable is itself a point worth fighting for (and fighting with our friends over). Assuming the courts will save us absolves our political leaders of both responsibility and accountability for allowing this kind of mischief to continue, and it absolves all of us of our responsibility to refuse to tolerate those who would just as quickly shrug their shoulders and move on. For those who aren’t paid subscribers, we’ll be back (no later than) Monday with our continuing coverage of the Supreme Court. For those who are, please read on.
Report: Latinos face 'unprecedented' health coverage losses amid cuts to Medicaid, ACA
The state with the nation's second highest number of uninsured — 858,000 Latinos — is Florida, according to the report. More than 71 million people with low incomes rely on Medicaid, which expanded under the Affordable Care Act.
Curing U.S. Health Care, Part II
On March 23, 2010 President Barack Obama signed the Patient Protection and Affordable Care Act — usually referred to either as the Affordable Care Act or as Obamacare — into law. Joe Biden, then the vice president, could be overheard whispering “This is a big fucking deal.” And it was. The ACA, which went into full effect in 2014, created a system of subsidies and regulations designed to make health insurance available to many Americans who had previously been left out. It worked: In 2010 there were 47 million uninsured people in America, but by 2016 this number had dropped to 27 million. This still fell short of the universal health insurance that every other advanced nation has, but it was real progress. In 2017, during his first term, Donald Trump tried to destroy the ACA, replacing it with the American Health Care Act — legislation that would have eliminated most of the provisions that expanded health insurance under Obama. At the time the Congressional Budget Office projected that the G.O.P.’s replacement bill would nearly double the number of Americans without health insurance, increasing the total uninsured population by 23 million and undoing all of the progress achieved under the ACA. However, the attack on Obamacare failed by one vote in the Senate, and the ensuing public backlash against the G.O.P. delivered a large victory in the 2018 midterms to the Democrats. After these developments many observers assumed that the ACA had become a more or less permanent feature of American life. Such assessments, however, failed to take into account the deep hostility of the U.S. right toward policies that expand access to healthcare. As we’ll see, this hostility goes back generations. And the second Trump administration has taken actions that the CBO projects will add 16 million people to the rolls of the uninsured by 2034. How did we get here? And now what? Today’s primer will analyze the political economy of U.S. healthcare since the 1940s and the combination of danger and opportunity created by the current crisis. Beyond the paywall I will discuss the following: US health care on the eve of Trump II 80 years of US health politics The Obamacare story The new assault on healthcare
Curing U.S. Health Care, Part I
In 2008, much to their own surprise, leading Democrats unified around a program of major health care reform. Policy wonks had spent years developing the concepts behind what eventually became Obamacare; big Democratic victories in the 2006 midterms and the prospect of controlling both Congress and the presidency made it possible to imagine turning those ideas into reality. During the Democratic primary, Hillary Clinton and Barack Obama advocated similar plans, based on those ideas, for expanding insurance coverage. And it happened! The Affordable Care Act was enacted in 2010. When it was fully implemented in 2014, millions of Americans got health insurance: Impressive as the raw numbers are, they don’t tell the whole story. Before the ACA, even upper-middle-class Americans often found it impossible to get health insurance if they had pre-existing medical conditions. Many Americans were trapped in jobs they wanted to leave but couldn’t for fear of losing their employment-based coverage. Meanwhile, dire predictions from the usual suspects about runaway costs proved wrong. In fact, overall U.S. medical spending has grown much more slowly since the ACA was enacted than before. But the U.S., alone among advanced nations, still falls far short of providing universal health care. As you can see from the chart above, 8 percent of the population was still uninsured in 2024, a number that is set to rise over the next two years as a result of Republican policies. True, many of the uninsured in 2024 were undocumented immigrants, who we don’t try to cover. But there are still a lot of uninsured. Moreover, a significant number of Americans who have health insurance are in fact underinsured. As a result, they are at risk of incurring devastating healthcare costs and are sometimes forced to forgo needed care. This number is set to rise sharply in the next two years as a result of Republican policies adopted under Donald Trump. And not only is the U.S. unique among advanced countries in its under-provision of health care coverage, it also incurs by far the world’s highest healthcare costs per capita. So now may well be a good time to get behind a new push for major health reform — an effort, if you like, to finish the job begun under Obama. Today’s primer is devoted to the economics of health reform. During his failed effort to repeal the Affordable Care Act, Donald Trump famously complained, “Nobody knew healthcare could be so complicated.” Actually, we did know — and it’s not that complicated. Health economists understand the principles very well. And because health policy varies greatly among advanced nations, we know a lot about what works and what doesn’t. This will be the first in a series about health reform. Beyond the paywall I’ll address the following: 1. Why markets can’t be trusted to deliver healthcare 2. Routes to universal healthcare 3. What works? In a follow-up post I’ll discuss the pros and cons of different approaches, and possible paths forward for the United States.
20 years after passing nation-leading health care law, Mass. braces for new challenges
A landmark health coverage law passed 20 years ago gave Massachusetts among the lowest uninsured rates in the country. It inspired the sweeping federal overhaul known as the Affordable Care Act. Now many are wondering whether that period of intense negotiations and compromise offers lessons for today's urgent health care challenges.
Double Take -- Sisco: America needs universal health care
Since the Affordable Care Act went into effect in 2010, millions of people were able to purchase health insurance. For many of these folks, though, making the monthly payments has
When Voters Worry About ‘Affordability,’ Many Point to Health Care
Democrats have had limited political success running on the Affordable Care Act, even with its relative popularity. Now President Trump’s health care cuts may have given the issue new resonance.
Is the ACA driving up healthcare costs? The evidence is mixed
What to know in the debate surrounding the role of the Affordable Care Act in driving up medical costs.
GOP 'big beautiful bill' poised to deliver 'shock' to ACA marketplace, health policy experts say
The GOP's "big beautiful bill" made administrative tweaks expected to reduce enrollment in the Affordable Care Act marketplace by millions of people.
When it comes to health insurance, federal dollars support more than ACA plans
Subsidies. Love ’em or hate them, they dominated the news during the Affordable Care Act’s sign-up season, and their reduction is now hitting many enrollees in the pocketbook.
Millions may drop ACA coverage — and raise health insurance costs for everyone else
Some experts warn of a potential "death spiral" in the Affordable Care Act marketplace if young, healthy consumers drop coverage amid soaring costs.
Fewer Ohioans sign up for healthcare coverage after ACA subsidies expire
Fewer Ohioans have signed up for health insurance through the Affordable Care Act this year—and cost appears to be a big reason why.
Important tax information issued on health coverage forms
As we approach tax season, Benefits Strategy is sharing information about Forms 1095-C and 1095-B, which are related to health insurance coverage under the Affordable Care Act.
Trump launches ‘Great Healthcare Plan,’ touting grab bag of initiatives
The proposal, coming ahead of the midterm elections, falls far short of President Donald Trump’s promises to deliver a replacement for the Affordable Care Act.
Republican Attacks on the Affordable Care Act Give Democrats an Opportunity to Court Small Business
As ACA subsidies expire, small business owners face soaring premiums. Republicans shrug—and Democrats have a chance to win them over.
US House Backs Extension of Health Insurance Subsidies After Dems Force Vote
WASHINGTON — The U.S. House approved a bipartisan bill Thursday to resurrect the enhanced tax credits that expired at the end of last year for people who purchase their health insurance from the Affordable Care Act marketplace. The 230-196 vote sends the legislation to the Senate, where Republican leadership is unlikely to put it on […]
House passes bill to extend health care subsidies in defiance of GOP leaders
In a remarkable rebuke of Republican leadership, the House passed legislation Thursday, 230-196, that would extend expired health care subsidies for those who get coverage through the Affordable Care Act.
GOP divisions on display as House votes to extend Obamacare subsidies
House Republicans bucked GOP leaders on Jan. 8 by voting to restore and extend the Affordable Care Act premium tax credits for three years.
House heading toward vote to extend health care subsidies in a rebuke of GOP leadership
In a remarkable rebuke of Republican leadership, the House is moving ahead Thursday on legislation that would extend expired health care subsidies for the Affordable Care Act.
On the Hook for Uninsured Residents, Counties Now Wonder How They’ll Pay
Millions of people gained health coverage under the Affordable Care Act, reducing pressure on counties in states that fund care for the uninsured. With federal policies expected to reverse that trend, county officials wonder how they will fill the gap — and who will pay for it.
Video Health insurance premiums set to soar as ACA subsidies expire
Millions of Americans who rely on the Affordable Care Act marketplace could see their premiums double or triple after subsidies end, Kaiser Family Foundation correspondent Julia Appleby explains.
US health insurance costs to rise by 114% for millions as subsidies expire
More than 20 million people in the United States will face sharply higher health insurance costs as of January 1 after enhanced tax credits that helped enrollees in the Affordable Care Act afford coverage…
Md. Rep. Glenn Ivey says the GOP is in trouble over health care premiums
Maryland Rep. Glenn Ivey believes that Republicans will have to address the elimination of the Affordable Care Act tax subsidies with health care premiums rising.
Why are health coverage costs increasing under the Affordable Care Act in North Carolina?
Rate hikes paired with the expiration of enhanced premium tax credits will increase out-of-pocket costs for NC residents.
Health Insurance Premiums to Skyrocket for Millions of Americans
Some 22 million Americans will begin to see their health insurance premiums skyrocket after Congress failed to extend certain subsidies under the Affordable Care Act, also known as Obamacare. NBC’s Christine Romans joins TODAY to break down what will happen when the subsidies expire, who is impacted and more.
Wisconsin small business owners fear loss of Affordable Care Act subsidies
State Democratic leaders join business owners to criticize Republicans who oppose extending tax credits for the Affordable Care Act.
Maggie Hassan says deal is still possible to avoid health insurance rate hikes
Senator Maggie Hassan discusses how time is running out to make a deal on health insurance subsidies under the Affordable Care Act.
Shopping for pricy ACA health plans? There may be cheaper options, but with trade-offs
Without a fix from Congress, costs for many people who buy health care on the Affordable Care Act marketplace have gone up. Here's what's to know about cheaper choices — and pitfalls to be aware of.
Trump’s Assault On Health Care, Seen From a Country That Does Health Care Better
Japan is a showcase for universal health care, and what we’re losing in GOP attacks on the Affordable Care Act.
Hand on Government: Rising health insurance costs and subsidy expiration threaten coverage for 1.5 million Floridians
As 2026 approaches, affordability remains a dominant concern for Americans, with health insurance costs poised to rise sharply, especially in Florida. Government law attorney Chris Hand explained on This Week in Jacksonville that the end of COVID-era subsidies for the Affordable Care Act (ACA) could have severe consequences.
Churches, clinics, hospitals brace for fallout as Alabamians see huge spikes in health insurance bills
Alabamians who rely on the marketplace will be left to figure out how to pay for skyrocketing insurance bills if the Affordable Care Act subsidies expire at the end of the year.
Millions of Californians to see health care premiums soar as federal subsidies set to expire
If the enhanced health care tax credits do expire as expected, insurance costs are expected to double, on average, for about 22 million people who get their coverage through the Affordable Care Act.
Stauber votes for Republican health care bill
The bill does not extend enhanced subsidies for the Affordable Care Act. If left to expire on Dec. 31, 22 million ACA enrollees would see their monthly health insurance premiums double on average.
LEADER JEFFRIES AHEAD OF VOTE ON GOP HEALTHCARE BILL: “REPUBLICANS NEED TO BRING THE AFFORDABLE CARE ACT TAX CREDIT EXTENSION BILL TO THE FLOOR TODAY”
Today, House Democratic Leader Hakeem Jeffries spoke on the House Floor, emphasizing that House Republicans have a responsibility to join House Democrats in protecting Americans’ healthcare after he received 218 signatures on his discharge petition to extend the ACA tax credits for three years. LEADER JEFFRIES: For months now, Democrats have made clear that we have a […]
House advances GOP health care package that doesn’t include ObamaCare subsidy extension
The House advanced a GOP health care bill Wednesday, even as moderate Republicans signed a Democratic discharge petition to extend the Affordable Care Act subsidies in an act of defiance against le…
Centrist Republicans revolt, signing a petition to force a vote on Obamacare funding
The Affordable Care Act subsidies are still expected to expire at the end of this year, however, raising insurance premiums for millions of Americans.
Can Lawmakers Find a Solution to Expiring Health Care Subsidies?
The United States Senate rejected a pair of health care bills that would have delivered relief to more than 20 million Americans before the end of the year. Now, cost-saving subsidies added to the Affordable Care Act in 2021 are likely to expire on New Year’s Eve, causing patient prices to increase by as much as 100%. NBC’s Anne Thompson reports in this week’s Sunday Focus.
Health insurance under Affordable Care Act to skyrocket after Senate fails to extend tax credits
Health care advocates and progressive groups across Florida said the U.S. Senate's failure to extend premium subsidies for the Affordable Care Act was a "disheartening setback" that will significantly raise the cost of health insurance for nearly 5 million Floridians, including hundreds of thousands of people in South Florida.
Higher cost, worse coverage: Affordable Care Act enrollees say expiring subsidies will hit them hard
Americans are feeling the strain already with less than three weeks to go until the expiration of COVID-era tax credits that have helped many people pay for health insurance through the Affordable Care Act.
Speaker Johnson unveils health care plan as divided Republicans scramble for alternative
The legislation, unveiled Friday, is a last-minute sprint as Johnson's party refuses to extend the enhanced tax subsidies for those who buy policies through the Affordable Care Act.
Sticker Shock: Obamacare Customers Confront Premium Spikes as Congress Dithers
With subsidies that give consumers extra help paying their health insurance premiums set to expire, lawmakers are again debating the Affordable Care Act. The difference this time: It’s happening in the middle of ACA open enrollment.
Watch live: Schumer, Senate Dems give remarks on rising health care premiums
Senate Democratic Leader Chuck Schumer (N.Y.) is holding a press conference Wednesday morning in support of extending health care subsidies under the Affordable Care Act as insurance premiums are s…
‘The Affordable Care Act saved my life": Pennsylvania home care worker worries about rising health insurance premiums
ACA approval hits new high: Gallup
More Americans approve of the Affordable Care Act (ACA) than at any point since it took effect more than a decade ago, according to a new Gallup survey. In the survey, released Monday, 57 percent o…
Swing district Republicans brace for political fallout if health care subsidies expire
House Republicans in key battleground districts are working to contain the political fallout expected when thousands of their constituents face higher bills for health insurance coverage obtained through the Affordable Care Act.
Swing district Republicans brace for political fallout if health care subsidies expire
House Republicans in key battleground districts are working to contain the political fallout expected when thousands of their constituents face higher bills for health insurance coverage obtained through the Affordable Care Act.
Covered CA expects 400,000 policy holders to be in limbo if health care subsidies aren't extended
Covered California, the state program that provides health care plans under the Affordable Care Act, is bracing for impacts if federal leaders don't extend COVID-19 era health care subsidies.
Health insurance premiums to double for over 500,000 Ohioans if ACA tax credits expire
Over half a million Ohioans face skyrocketing premiums if federal tax credits to help pay for their plans under the Affordable Care Act expire at year's end, with some families paying nothing now potentially owing thousands.
A way forward for making health insurance more affordable
After 43 days of a government shutdown, eight Democratic senators crossed the aisle and voted in favor of a Republican bill to extend the enhanced tax credits for the Affordable Care Act, which are…
Health savings accounts, backed by GOP, cover fancy saunas but not insurance premiums or formula
Trump and some Republicans are pitching the accounts as an alternative to expiring enhanced federal subsidies for the Affordable Care Act.
Health insurance costs could spike, as bipartisan ACA deal looks less likely
With a ticking clock and no clear bipartisan path forward, extending the Affordable Care Act subsidies is becoming more challenging.
Hopes fade in Congress for a health care deal before premiums soar in January
Billions of dollars in tax credits under the Affordable Care Act are poised to expire at the end of the year. Lawmakers in both parties say they're nowhere close to a deal to renew them.
Klobuchar says Senate ACA vote ‘will happen’ before New Year
Sen. Amy Klobuchar predicted Sunday that the Senate will hold a vote on extending subsidies offered under the Affordable Care Act (ACA) this year. “That vote will happen. And whether it will …