Nicole Rapfogel
@nicolerapfogel.bsky.social
health policy nerd | sr policy analyst @centeronbudget.bsky.social | formerly CMS and @americanprogress.bsky.social | opinions mine
As I was quoted in this article: "Most people do not have spare cash to set aside in HSAs."
HSAs don't help the people with low and moderate incomes most affected by expiring PTC enhancements, don't help people get health coverage, and just don't make sense for most Americans.
HSAs don't help the people with low and moderate incomes most affected by expiring PTC enhancements, don't help people get health coverage, and just don't make sense for most Americans.
Republicans facing voter ire over spiking health premiums are resurrecting one of their favorite ideas: give people power to pay for medical care on their own, with tax-free dollars in individual health savings accounts.
Why health savings accounts aren’t the fix Republicans hope for
The idea of sending cash directly into health savings accounts appeals to some Republicans after President Donald Trump demanded a solution that bypasses insurers.
www.washingtonpost.com
November 26, 2025 at 4:23 PM
As I was quoted in this article: "Most people do not have spare cash to set aside in HSAs."
HSAs don't help the people with low and moderate incomes most affected by expiring PTC enhancements, don't help people get health coverage, and just don't make sense for most Americans.
HSAs don't help the people with low and moderate incomes most affected by expiring PTC enhancements, don't help people get health coverage, and just don't make sense for most Americans.
Reposted by Nicole Rapfogel
Some recent Republican responses to the marketplace premium tax credit issue would shift more people to bronze plans with Health Savings Accounts as an alternative to silver plans with PTC enhancements and cost sharing reductions. So how do these plans stack up in real terms?
November 24, 2025 at 9:25 PM
Some recent Republican responses to the marketplace premium tax credit issue would shift more people to bronze plans with Health Savings Accounts as an alternative to silver plans with PTC enhancements and cost sharing reductions. So how do these plans stack up in real terms?
The GAO released a report last week on health savings accounts (HSAs) reaffirming that HSAs do little to help people with low and moderate incomes – who would be hurt the most if Congress lets premium tax credit enhancements expire.
GAO-25-107480, HEALTH SAVINGS ACCOUNTS: Information on Features and Use,
and Characteristics of Account Holders
files.gao.gov
November 24, 2025 at 8:42 PM
The GAO released a report last week on health savings accounts (HSAs) reaffirming that HSAs do little to help people with low and moderate incomes – who would be hurt the most if Congress lets premium tax credit enhancements expire.
Reposted by Nicole Rapfogel
Here they go again: Republicans in Congress are reviving the ACA repeal debate. After enacting unprecedented cuts to Medicaid, they are looking for ways to eliminate federal premium tax credits that some help about 20M people afford marketplace plans.
November 20, 2025 at 10:16 PM
Here they go again: Republicans in Congress are reviving the ACA repeal debate. After enacting unprecedented cuts to Medicaid, they are looking for ways to eliminate federal premium tax credits that some help about 20M people afford marketplace plans.
Today, the Senate Finance Committee held a hearing on rising health care costs. But the real, urgent focus should be that 20 million people would face higher premium costs if the PTC enhancements expire at the end of the year.
Here’s how real people will are affected.
Here’s how real people will are affected.
November 19, 2025 at 9:05 PM
Today, the Senate Finance Committee held a hearing on rising health care costs. But the real, urgent focus should be that 20 million people would face higher premium costs if the PTC enhancements expire at the end of the year.
Here’s how real people will are affected.
Here’s how real people will are affected.
Reposted by Nicole Rapfogel
My colleague @nicolerapfogel.bsky.social talked with CQ this week about why Republican HSA and cash account proposals are no substitute for extending the soon-to-expire PTC enhancements that more than 20 million ACA marketplace enrollees rely on to keep coverage affordable.
As I told CQ, the Republican HSA and other cash account proposals are no real alternative to extending PTC enhancements and won't make health coverage more affordable.
“These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
“These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
CQ NEWS House GOP not ready to embrace Senate’s health account idea
Republicans, who had been unified on the need to reopen the government, seemed less united Wednesday on the next step — how to address the upcoming health care subsidy cliff.
plus.cq.com
November 13, 2025 at 8:57 PM
My colleague @nicolerapfogel.bsky.social talked with CQ this week about why Republican HSA and cash account proposals are no substitute for extending the soon-to-expire PTC enhancements that more than 20 million ACA marketplace enrollees rely on to keep coverage affordable.
As I told CQ, the Republican HSA and other cash account proposals are no real alternative to extending PTC enhancements and won't make health coverage more affordable.
“These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
“These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
CQ NEWS House GOP not ready to embrace Senate’s health account idea
Republicans, who had been unified on the need to reopen the government, seemed less united Wednesday on the next step — how to address the upcoming health care subsidy cliff.
plus.cq.com
November 13, 2025 at 8:22 PM
As I told CQ, the Republican HSA and other cash account proposals are no real alternative to extending PTC enhancements and won't make health coverage more affordable.
“These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
“These proposals are somewhat unserious. They lack the details, they're unclear on the mechanisms, they don't make policy sense.”
Expanding HSAs would do nothing to address impending premium increases for some 22 million people with low/moderate incomes who are facing higher costs.
Instead, Congress should extend premium tax credit enhancements to ensure enrollees continue to have access to affordable health coverage.
Instead, Congress should extend premium tax credit enhancements to ensure enrollees continue to have access to affordable health coverage.
Expanding Health Savings Accounts Would Do Little to Improve Access to Affordable Health Care
Amid the urgent debate over whether Congress will act to prevent cost increases for millions of people in 2026 marketplace plans, some Republicans are promoting expansions of health savings accounts.....
www.cbpp.org
November 11, 2025 at 9:28 PM
Expanding HSAs would do nothing to address impending premium increases for some 22 million people with low/moderate incomes who are facing higher costs.
Instead, Congress should extend premium tax credit enhancements to ensure enrollees continue to have access to affordable health coverage.
Instead, Congress should extend premium tax credit enhancements to ensure enrollees continue to have access to affordable health coverage.
Reposted by Nicole Rapfogel
HSAs are tax shelters masquerading as health policy. They don't help people who are struggling to afford health coverage.
Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx
Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx
Expanding Health Savings Accounts Would Do Little to Improve Access to Affordable Health Care
Amid the urgent debate over whether Congress will act to prevent cost increases for millions of people in 2026 marketplace plans, some Republicans are promoting expansions of health savings accounts.....
tinyurl.com
November 11, 2025 at 4:04 PM
HSAs are tax shelters masquerading as health policy. They don't help people who are struggling to afford health coverage.
Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx
Read more from @nicolerapfogel.bsky.social: tinyurl.com/fh5rabhx
Reposted by Nicole Rapfogel
Open enrollment for #ACA marketplace plans has begun, and without congressional action to extend premium tax credit enhancements, millions are facing steep premium increases for 2026.
November 5, 2025 at 2:57 PM
Open enrollment for #ACA marketplace plans has begun, and without congressional action to extend premium tax credit enhancements, millions are facing steep premium increases for 2026.
Reposted by Nicole Rapfogel
Georgia’s 2026 ACA marketplace window shopping began October 1, meaning people are already seeing next year’s premiums spike because of expiring tax credit enhancements. A typical 60-year-old couple making $85,000 in Georgia will face a $24,900 increase in annual premiums. (1/4)
October 7, 2025 at 1:15 PM
Georgia’s 2026 ACA marketplace window shopping began October 1, meaning people are already seeing next year’s premiums spike because of expiring tax credit enhancements. A typical 60-year-old couple making $85,000 in Georgia will face a $24,900 increase in annual premiums. (1/4)
Reposted by Nicole Rapfogel
Some policymakers say that that Congress can delay extending the Premium Tax Credit (PTC) enhancements until later this year but the problem is more urgent than that. thehill.com/policy/healt...
thehill.com
October 6, 2025 at 8:12 PM
Some policymakers say that that Congress can delay extending the Premium Tax Credit (PTC) enhancements until later this year but the problem is more urgent than that. thehill.com/policy/healt...
Reposted by Nicole Rapfogel
Since 2021, ACA marketplace enrollment more than doubled for people with low incomes and for Black and Latino enrollees after premium tax credit enhancements. (1/4)
October 2, 2025 at 2:46 PM
Since 2021, ACA marketplace enrollment more than doubled for people with low incomes and for Black and Latino enrollees after premium tax credit enhancements. (1/4)
Reposted by Nicole Rapfogel
Premium tax credit enhancements help tipped workers, veterans, small business workers, farmers, and older people afford health coverage. Their premiums will soon spike and millions of them will lose coverage if the enhancements expire. (1/5)
October 1, 2025 at 6:29 PM
Premium tax credit enhancements help tipped workers, veterans, small business workers, farmers, and older people afford health coverage. Their premiums will soon spike and millions of them will lose coverage if the enhancements expire. (1/5)
Reposted by Nicole Rapfogel
As Democrats push to reverse the megabill’s health care cuts and stop imminent cost increases in the marketplaces, Republicans have made false claims about who would benefit from these restorations in affordable health coverage. www.americanprogressaction.org/article/repu...
Republicans Are Telling Lies About Undocumented Immigrants To Deflect Blame for Health Care Cost Increases They Supported
Republican inaction on premium tax credits will cause health insurance costs to soar for more than 20 million people.
www.americanprogressaction.org
September 30, 2025 at 7:47 PM
As Democrats push to reverse the megabill’s health care cuts and stop imminent cost increases in the marketplaces, Republicans have made false claims about who would benefit from these restorations in affordable health coverage. www.americanprogressaction.org/article/repu...
Reposted by Nicole Rapfogel
If Congress allows the enhanced premium tax credits to expire at the end of this year, ACA Marketplace enrollees on average would see their out-of-pocket premium payments grow by 114%, from an average of $888 in 2025 to $1,904 in 2026: https://on.kff.org/3WfWxjj
September 30, 2025 at 7:41 PM
If Congress allows the enhanced premium tax credits to expire at the end of this year, ACA Marketplace enrollees on average would see their out-of-pocket premium payments grow by 114%, from an average of $888 in 2025 to $1,904 in 2026: https://on.kff.org/3WfWxjj
Reposted by Nicole Rapfogel
Why are #ACA marketplace plans with $0 premiums important? My colleague @nicolerapfogel.bsky.social explains:
NEW from @centeronbudget.bsky.social: Without Congressional action, premium tax credit enhancements will expire, raising costs for nearly all marketplace enrollees and putting millions of those with the lowest incomes at risk of becoming uninsured when they lose $0 premium plans.
People With Low Incomes May Lose $0 Premium Plans — a Lifeline — Unless Congress Acts | Center on Budget and Policy Priorities
Everyone should be able to get the health care they need to thrive, and for that to happen, it must be affordable, high quality, and easily accessible for all. Premium tax credit (PTC) enhancements...
www.cbpp.org
September 30, 2025 at 3:28 PM
Why are #ACA marketplace plans with $0 premiums important? My colleague @nicolerapfogel.bsky.social explains:
NEW from @centeronbudget.bsky.social: Without Congressional action, premium tax credit enhancements will expire, raising costs for nearly all marketplace enrollees and putting millions of those with the lowest incomes at risk of becoming uninsured when they lose $0 premium plans.
People With Low Incomes May Lose $0 Premium Plans — a Lifeline — Unless Congress Acts | Center on Budget and Policy Priorities
Everyone should be able to get the health care they need to thrive, and for that to happen, it must be affordable, high quality, and easily accessible for all. Premium tax credit (PTC) enhancements...
www.cbpp.org
September 30, 2025 at 3:10 PM
NEW from @centeronbudget.bsky.social: Without Congressional action, premium tax credit enhancements will expire, raising costs for nearly all marketplace enrollees and putting millions of those with the lowest incomes at risk of becoming uninsured when they lose $0 premium plans.
Reposted by Nicole Rapfogel
More than 2 in 5 veterans enrolled in the ACA marketplace will lose their coverage if premium tax credit enhancements expire, out of the 623,000 veterans who would otherwise have marketplace coverage in 2026. New Urban Institute estimates here: tinyurl.com/2bs4aj2j
tinyurl.com
September 29, 2025 at 8:49 PM
More than 2 in 5 veterans enrolled in the ACA marketplace will lose their coverage if premium tax credit enhancements expire, out of the 623,000 veterans who would otherwise have marketplace coverage in 2026. New Urban Institute estimates here: tinyurl.com/2bs4aj2j
NEW from @jenniferlsullivan.bsky.social and me for @centeronbudget.bsky.social: With Congress poised to take away premium tax credit enhancements soon, ~4M people will lose coverage and costs will rise for nearly all ACA marketplace enrollees unless Congress acts.🧵
Five Key Changes to ACA Marketplaces Amid Uncertainty Over Premium Tax Credit Enhancements | Center on Budget and Policy Priorities
Recent policy changes, most notably enhancements to premium tax credits to reduce enrollees’ health insurance premiums, have driven record-breaking enrollment gains and delivered reduced costs, simpli...
www.cbpp.org
September 23, 2025 at 2:52 PM
NEW from @jenniferlsullivan.bsky.social and me for @centeronbudget.bsky.social: With Congress poised to take away premium tax credit enhancements soon, ~4M people will lose coverage and costs will rise for nearly all ACA marketplace enrollees unless Congress acts.🧵
Reposted by Nicole Rapfogel
My colleague @nicolerapfogel.bsky.social and I write about five key changes coming to #ACA marketplaces this fall. TLDR? Nearly all enrollees will face higher costs unless Congress extends the Premium Tax Credit enhancements.
Five Key Changes to ACA Marketplaces Amid Uncertainty Over Premium Tax Credit Enhancements | Center on Budget and Policy Priorities
Recent policy changes, most notably enhancements to premium tax credits to reduce enrollees’ health insurance premiums, have driven record-breaking enrollment gains and delivered reduced costs, simpli...
www.cbpp.org
September 22, 2025 at 8:41 PM
My colleague @nicolerapfogel.bsky.social and I write about five key changes coming to #ACA marketplaces this fall. TLDR? Nearly all enrollees will face higher costs unless Congress extends the Premium Tax Credit enhancements.
Reposted by Nicole Rapfogel
Eliminating the PMF program as President Trump ordered could mean losing a new generation of bright public servants. PMF alums @andrewpmiller.bsky.social and Kelly Razzouk explain in @justsecurity.org:
Save the PMF Program or Risk Losing a Generation of Public Servants
The Trump administration's elimination of the PMF program will have negative long-term consequences for an entire generation of policymakers.
www.justsecurity.org
August 6, 2025 at 1:01 PM
Eliminating the PMF program as President Trump ordered could mean losing a new generation of bright public servants. PMF alums @andrewpmiller.bsky.social and Kelly Razzouk explain in @justsecurity.org:
In addition to restricting marketplace eligibility and increasing burdensome red tape in the budget bill, CMS finalized a rule that would cause 1.8M people to lose coverage in 2026 alone.
More on the details and major issues 👇
More on the details and major issues 👇
June 20, 2025: Executive Action Watch | Center on Budget and Policy Priorities
The Centers for Medicare & Medicaid Services (CMS) finalized a rule that will make Affordable Care Act marketplace coverage less affordable for enrollees, create new barriers to enrolling in and...
www.cbpp.org
July 10, 2025 at 8:29 PM
In addition to restricting marketplace eligibility and increasing burdensome red tape in the budget bill, CMS finalized a rule that would cause 1.8M people to lose coverage in 2026 alone.
More on the details and major issues 👇
More on the details and major issues 👇
Reposted by Nicole Rapfogel
Up to 1.8M people will lose #ACA marketplace coverage in 2026 alone under a new federal rule that will make coverage less affordable for enrollees.
More from @nicolerapfogel.bsky.social: www.cbpp.org/research/fed...
More from @nicolerapfogel.bsky.social: www.cbpp.org/research/fed...
June 20, 2025: Executive Action Watch | Center on Budget and Policy Priorities
The Centers for Medicare & Medicaid Services (CMS) finalized a rule that will make Affordable Care Act marketplace coverage less affordable for enrollees, create new barriers to enrolling in and...
www.cbpp.org
July 10, 2025 at 7:24 PM
Up to 1.8M people will lose #ACA marketplace coverage in 2026 alone under a new federal rule that will make coverage less affordable for enrollees.
More from @nicolerapfogel.bsky.social: www.cbpp.org/research/fed...
More from @nicolerapfogel.bsky.social: www.cbpp.org/research/fed...
Reposted by Nicole Rapfogel
The new CBO score is out for the "Big Beautiful Bill." Topline? 10.9m people will lose coverage. Combined with previous CBO estimates (updated numbers could be coming soon) of cuts slated for the end of the year for ACA premium tax credits we could be looking at 16m uninsured.
Disgraceful.
Disgraceful.
June 4, 2025 at 2:29 PM
The new CBO score is out for the "Big Beautiful Bill." Topline? 10.9m people will lose coverage. Combined with previous CBO estimates (updated numbers could be coming soon) of cuts slated for the end of the year for ACA premium tax credits we could be looking at 16m uninsured.
Disgraceful.
Disgraceful.