Trump’s new ACA rule piles on red tape, drops 2 million people from coverage, and greenlights ultra-high-cost, no‑network plans; the article unpacks how these changes shift power to insurers.
The Trump administration finalized extensive new Affordable Care Act marketplace regulations on May 20, 2026, that impose new administrative burdens on consumers while granting unprecedented flexibility to health insurers. The rule arrives as marketplace premiums have doubled after Congress cut funding for premium tax credits, causing enrollment to decline for the first time since 2020.
The new rule projects that added paperwork and verification requirements for millions of low-income enrollees and most midyear applicants will cause up to 2 million people to lose coverage. Research shows these administrative burdens disproportionately drive younger, healthier consumers out of the insurance market. As the remaining insured pool becomes relatively sicker, the cost of coverage rises for everyone.
At the same time, the administration relaxes consumer protections and insurer standards in several novel ways. Starting in 2027, bronze plans may impose out-of-pocket maximums at 130 percent of the statutory limit—$15,600 for individuals and $31,200 for families—with catastrophic plans required to match these levels in 2028. The rule also permits “nonnetwork” plans where all providers are out-of-network, exposing enrollees to surprise medical bills for nearly all non-emergency care while depressing the benchmark that determines premium tax credits for all consumers. Additionally, insurers can now market skimpy catastrophic coverage to most adults, regardless of age or prior hardship restrictions, and may offer multiyear catastrophic plans lasting up to 10 years. The rule even suggests consumers could request loans from insurers to cover unaffordable deductibles.
Several of these policies face immediate legal challenges, with plaintiffs arguing that the changes exceed administrative authority and lack adequate justification. The rule reveals clear priorities: reducing marketplace enrollment through consumer red tape while allowing insurers to shift more costs and risks to enrollees.
Read the details in the full 1,121-page report here:
https://www.cms.gov/files/document/cms-9883-f-patient-protection.pdf
An easier-to-read analysis:
https://www.healthaffairs.org/content/forefront/hhs-finalizes-sweeping-marketplace-changes-part-1-higher-bronze-deductibles-and
The Commonwealth Fund report on this rule change:
https://www.commonwealthfund.org/blog/2026/trump-administrations-new-aca-marketplace-rule-gives-insurance-companies-flexibility
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