Republicans poised to steal gold from Texans

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To fund Trump’s depraved, immoral and illegal assault on Iran, Axios reports that a Texas sage is proposing a fresh cut to ACA marketplace premiums:

House Budget Committee Chairman Jodey Arrington (R-Texas) is reviving an idea that was considered last year to fund Affordable Care Act payments known as cost-sharing reductions [CSR].

• The Congressional Budget Office previously found the move would lower overall benchmark ACA premiums by 11% but result in 300,000 more uninsured people.

• It would have the effect of cutting the subsidy amount that some enrollees receive, thereby increasing out-of-pocket premium costs, while saving the government over $30 billion.

That proposal would kill silver loading, which would have the most profound effects in Arrington’s Texas, where the pricing of silver plans at platinum levels mandated by statute renders gold plans far cheaper than silver plans and makes free bronze coverage available to almost all enrollees. Before Republicans in Congress seek to end the practice, the 1.7 million Texans in gold plans and likely 800,000-plus in zero-premium bronze plans might want a word.

ACA Marketplace 2026: The downshift to bronze

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Charles Gaba, via a trick that presents itself to the highly motivated, has got hold of the 2026 Public Use Files (PUFs) for the ACA marketplace before they’re officially announced and has parsed them 26 ways. He’s also kindly shared the trick, and so the file.

I want to continue my focus on the degradation of coverage — that is, the shift to lower metal levels, and in particular, the shift away from silver among those eligible for strong Cost Sharing Reduction (CSR), which raises the actuarial value of a silver plan from a baseline of 70% to 94% (at incomes up to 150% of the Federal Poverty level) or 87% (for those in the 150-200% FPL) range.*

For starters, here is the metal level breakdown for all states in 2025 vs. 2026.

Accelerating a multi-year trend, silver selection fell sharply. a shift modestly offset by an increase in gold selection, as three states (Washington, Arkansas, Illinois) newly implemented strict silver loading in 2026, rendering gold plans less expensive than silver (in Illinois and Arkansas, 31% of enrollees selected gold plans, and in Washington, 51% selected gold).

Triage for U.S. healthcare: Families USA's Stop the Bleed campaign

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In the United States today, as rising healthcare costs for individuals and government alike approach a crisis point, major systemic change enacted by legislation feels utopian. Behemoths stalk the healthcare landscape: Mega-insurers control major PBMs, large numbers of physician practices, and tech tools to maximize billing; hospital systems dominate their regions; pharmaceuticals maximize pricing power over fractured payers; private equity firms roll up major physician specialist practices within target markets and dominate target services like hospice and dialysis.

These powerful actors deploy our corrupt campaign financing rules to deter elected officials from both parties from enacting legislation that would fundamentally threaten their current revenue sources. A single-payer system, or a strong public option available to all, or a national system of all-payer rate-setting, are not likely to happen this side of revolution (including, on the hopeful side, political revolution).

In tacit acknowledgment of those facts, Families USA has launched Stop the Bleed — almost literally a triage campaign to provide some cost relief to the people of this country. The campaign invites healthcare advocates — and anyone who wants to sign up — to ask candidates for electoral office from both parties and at any level what they propose to do to control healthcare costs.