The Estimated Effects of Enacting Selected Health Coverage Policies on the Federal Budget and on the Number of People With Health Insurance

CBO was asked for information concerning the estimated effects on federal deficits and health insurance coverage that would occur if the following changes to current law were enacted on September 30, 2025:

• Permanently expand the premium tax credit structure as provided in the American Rescue Plan Act of 2021 and later extended through calendar year 2025 in the 2022 reconciliation act—increasing the deficit by $350 billion from 2026 to 2035 and the number of people with health insurance by 3.8 million in 2035,
• Nullify a final rule published in June 2025 by the Department of Health and Human Services related to the health insurance marketplaces established by the Affordable Care Act—increasing the deficit by $40 billion from 2026 to 2035 and the number of people with health insurance by 300,000 in 2035, and
• Repeal sections in title VII, subtitle B, of the 2025 reconciliation act related to the health insurance marketplaces—increasing the deficit by $272 billion from 2026 to 2035 and the number of people with health insurance by 2.9 million in 2035.

CBO and the staff of the Joint Committee on Taxation estimate that each policy would increase federal deficits over the 2026–2035 period relative to CBO's baseline projections updated to reflect administrative actions and legislation enacted through August 22, 2025. CBO also estimates that each policy would increase the number of people with health insurance in each of the next 10 years.