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Insuring Growth explores the biggest challenges and opportunities facing health insurance leaders, focusing on what executives need to know now.
As 2026 approaches, policy shifts are set to transform the ACA marketplace and Medicaid, creating ripple effects across the health insurance ecosystem. In Episode #3 of Insuring Growth, host and e123 President, Brendan McLoughlin, talks with Dr. Makayla Lavender, Health Economics Professor at the University of Nevada, Las Vegas, about what these changes mean for health plans, carriers, brokers, and the millions of members they serve.
The conversation examines how expiring subsidies and new verification requirements will alter the economics of ACA plans. During the Biden administration, enhanced subsidies expanded eligibility beyond 400% of the federal poverty line and made coverage more affordable. Under the current administration, those benefits are scheduled to end after 2025, causing many consumers to either face higher premiums or downgrade their coverage tier. Others may look to off-exchange plans as a lower-cost option.
Dr. Lavender also highlights a major procedural change: the end of automatic re-enrollment. Beginning in 2026, every household must re-verify income each year, creating extra work for brokers who will need to guide clients through the process and prevent coverage lapses. Meanwhile, the federal open-enrollment window is poised to shrink, tightening the timeline for marketing, education, and case management.
For health plans and carriers, these adjustments will require new strategies around pricing and member retention. As subsidy levels drop, risk pools could shift, and rates may need to adjust faster than in previous years. For brokers and agencies, automation and CRM tools will become essential for managing renewals within a condensed enrollment period.
Despite the challenges, Dr. Lavender notes that change brings opportunity. Plans that help brokers communicate clearly, streamline verification, and offer competitive off-exchange alternatives will be best positioned to maintain growth during the transition.
Actionable Insights for Decision Makers
Review your member base to identify who may lose eligibility when enhanced subsidies expire. Equip agents with digital tools that support real-time eligibility checks and renewal tracking. Simplify communication so consumers understand verification deadlines and plan changes.
Episode #3 is available now and is a must-listen for anyone preparing for the next wave of ACA reform.
Insuring Growth isn’t just another industry podcast. It’s where decision-makers get real, actionable intelligence from leaders who have been there and done it. If you’re interested in being a guest and discussing the challenges facing healthcare and insurance leaders, reach out to podcast@enrollment123.com.
