We thought our readers might be interested in how the BBB modified ACA. According to the Kaiser Family Foundation, via its KFF website, there were at least seven notable changes that the 2025 legislation made to ACA. These are summarized below.
Pre-enrollment Verification. Under Obamacare, new enrollees must verify their eligibility to obtain the ACA tax credit. They are granted conditional eligibility if there is a mismatch in the information they provided and federal databases. Enrollees can retain coverage and tax credits for up to 90 days while submitting verification documents. Returning enrollees who take no action during open enrollment are auto-renewed into the same or similar plan. Nearly half of ACA Marketplace enrollees in 2025 auto-renewed.
Re-enrollment verification continues to be required under the BBB but with the following changes:
- Exchanges do not have to additionally verify consumer eligibility for cost-sharing reductions (CSRs) before a consumer can qualify for premium tax credits (PTCs).
- Exchanges must use applicant’s “household income” for verification.
- Exchanges must verify whether applicant is an “eligible alien.”
- Exchanges can use any third-party sources and any available data for verification.
- Verification requirements may be waived for individuals enrolling during special enrollment periods (SEPs) due to changes in family size.
The effective dates for these changes include taxable years beginning after December 31, 2027.
Recapture of Excess Premium Tax Credits. Under ACA, if an enrollee receives excess premium tax credits because their estimated income was lower than their actual income, they must repay the excess. However, for most enrollees, there is a repayment cap that varies based on household income. For enrollees with household incomes over 400% of the federal poverty level (FPL), there is no limit. They must repay the entirety of their excess tax credit. Other repayment limits vary from $375 for a single person with an income that is less than 200% FPL to $3,150 for families with an income between 300% and 400% FPL.
The BBB requires all premium tax credit recipients to repay the full amount of any excess, regardless of their income. The effective dates are taxable years beginning after December 31, 2025.
Eligibility for Lawful Immigrants. Under ACA, U.S. citizens and lawfully present immigrants are eligible to enroll in ACA Marketplace coverage and receive premium subsidies and cost-sharing reductions. Lawful immigrants with incomes under 100% of the FPL who do not qualify for Medicaid coverage due to their immigration status also are eligible for ACA Marketplace coverage.
The BBB restricts subsidized ACA Marketplace coverage eligibility for certain immigrants, with some notable differences. First, an exemption for certain immigrants from Cuba from restrictions on ACA subsidies was revised and expanded to cover “Cuban and Haitian entrants as defined in section 501(e) of the Refugee Education Assistance Act of 1980.” Second, the new provisions do not restrict eligibility for Basic Health Programs to specific classes of eligible aliens.
Special Enrollment Periods. In addition to qualifying life events (QLEs) that enable eligibility for an SEP, people in states that use federally facilitated marketplaces (FFMs) and make no more than 150% of the federal poverty level can apply for a year-round SEP to sign up for coverage under Obamacare. Some state-based exchanges also offer SEPs that are based on the relationship of people's income to the poverty line. Any person who enrolls in a plan via an SEP is eligible for both premium tax credits and CSRs. In 2025, enrollees with an income of less than 150% of the federal poverty line made up the largest share of all Marketplace enrollees (47%).
The BBB bars any consumer who enrolls in a plan via a non-QLE SEP from receiving either premium tax credits or CSRs. The effective dates include plan years beginning after December 31, 2025.
Tax Credits and Medicaid. Under ACA, Medicaid eligible individuals are not eligible for premium tax credits on the Marketplace, regardless of whether they are enrolled in Medicaid.
The BBB specifies that if a person is denied or disenrolled from Medicaid due to work requirements, they are also ineligible for subsidized Marketplace coverage. The effective date is January 1, 2027 or earlier at state option.
Filing and Reconciling. Enrollees under ACA who receive any amount of premium tax credits must file and reconcile their premium tax credits every two years. Failure to do so will lead to ineligibility for premium tax credits. In 2025, about 92% of Marketplace enrollees or over 22 million people received premium tax credits.
The BBB restricts premium tax credit eligibility for enrollees who fail to file and reconcile their premium tax credits for one year. The effective dates include taxable years beginning after December 31, 2027.
The foregoing represents a snapshot of some of the changes the BBB has made to Obamacare. Analysts of varying stripes have rushed to produce their take on what all this will mean for providers, for hospitals and for American healthcare in general. But above all the predictions, prognostications and noise, here’s one truism we can take to the bank: laws and regs are ever-changing. Just as ACA was changed by the BBB, something will come along to tweak, revise or repeal the BBB. It's just a matter of when.