Congress recently passed the One Big Beautiful Bill Act (OBBBA), which was signed into law July 4 by President Trump. This bill will cut an estimated $300 billion from the Supplemental Nutrition Assistance Program (SNAP) and $1 trillion from Medicaid, as well as make it harder and less affordable to enroll in health plans through the Affordable Care Act’s Health Insurance Marketplace.
Currently, more than 24 million Americans receive their health coverage through Marketplace plans. In Kansas, more than 200,000 people receive their health insurance through this program. In 45 Kansas counties, at least 7% of Kansans are enrolled in Marketplace coverage. And, many counties with the highest Marketplace enrollment are in rural areas.
To help people afford plans in the Marketplace, the federal government provides low- and middle-income individuals with premium tax credits. In 2021, Congress enhanced the tax credits to make them available to even more people. Authorized originally by the American Rescue Plan Act, the enhanced premium tax credits were later extended by the Inflation Reduction Act through 2025. These changes made Marketplace plans more affordable and led to double the enrollment from 2021 to 2025.
However, provisions in OBBBA will make it harder for individuals to enroll or re-enroll in subsidized coverage through the Marketplace. Most provisions begin in the 2026 plan year. And, unless Congress acts, the enhanced premium tax credits will expire at the end of 2025. That will lead to higher costs for Marketplace enrollees and an increase in uninsured Kansans.
This comes as the Centers for Medicare & Medicaid Services (CMS) issued a final rule in June 2025 that restricts eligibility, reduces benefits and adds new paperwork requirements — all of which take effect in 2025 and 2026. According to the Congressional Budget Office (CBO), Marketplace enrollment is expected to decline significantly due to OBBBA and other federal policy decisions. At the same time, steep cuts to a critical federal program that helps people navigate and enroll in Marketplace coverage will make it even harder for people to get insured.
We recently released a research brief that highlights how these changes will impact access to Marketplace health insurance in Kansas.
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