CFRA’s Washington Analysis Healthcare team breaks down why 2025 may mark the effective dissolution of the Affordable Care Act (ACA) as we know it. From sweeping funding cuts in Medicaid, enrollment caps, key Supreme Court rulings and a shifting regulatory environment, Marketplace insurers like Centene (CNC), Molina (MOH), Oscar Health (OSCR) and UnitedHealth (UNH) face significant and often underappreciated headwinds.
While the expiration of enhanced premium tax credits loom at the end of the year, the near term legislative actions embedded within the “One Big Beautiful Bill” could further destabilize the ACA Marketplace. Add to that the Supreme Court's upcoming decision in Kennedy v. Braidwood Management, and the risk of increased cost burdens and insurer exits grows.
But there’s another side to the story. As traditional ACA frameworks come under pressure, Congress is making room for alternatives. Health Savings Accounts (HSAs) and Individual Coverage Health Reimbursement Arrangements (ICHRAs)—soon to be rebranded as CHOICE arrangements—which offer tax incentives to individuals and small business to expand coverage are receiving new support in proposed legislation. However, the outcome remains uncertain. Should Congress move forward with this reforms, the WA Healthcare Team expects this could signal strong tailwinds for HealthEquity (HQY), Optum Bank (UNH), Benefitfocus (BNFT), HQY, GoHealth (GOCO) and eHealth (EHTH).
This research report provides a comprehensive look at both the risks and opportunities reshaping U.S. health insurance policy in 2025.
Authors:
Tatiana Brown Johnson, Senior Vice President, Policy Analyst
Monet Stanford, Senior Vice President, Healthcare Policy
What You Will Learn
- Why insurers may face margin pressure and exits from the ACA Marketplace
- How the “One Big Beautiful Bill” reshapes Medicaid and premium tax credits
- The Supreme Court case that could upend cost-free preventive coverage
- Tailwinds for HSAs and CHOICE arrangements as new coverage models gain traction
- Implications for companies like HealthEquity, GoHealth, and Optum Bank
Download the complete analysis to understand how 2025 policy changes could transform the healthcare coverage landscape and what’s next for insurers and alternative providers.