Despite subsidy uncertainties, ACA enrollment is higher than last year

The number of Americans signing up for health insurance through the ACA for 2026 is slightly higher than it was at a similar time last year, according to federal data, despite uncertainties around subsidies for ACA plans that are slated to expire at the end of the year.

According to CMS, nearly 5.8 million Americans have signed up for an ACA plan by day 29 of the open enrollment window, which is nearly 400,000 more enrollments than by day 30 of the window last year. However, this year's enrollment numbers so far are around 1.5 million lower than the roughly 7.3 million people who signed up for ACA plans 32 days into the open enrollment window two years ago.

The news comes among uncertainties surrounding expanded subsidies for ACA plans that are slated to expire by the end of 2025 that will likely lead to more expensive plans that will cover less. According to KFF, the average deducible for a Bronze ACA plan — the least expensive kind of plan available to everyone — has climbed from $7,000 in 2021 to $7,500 in 2026.

According to Cynthia Cox, an ACA expert for KFF, people looking to enroll in ACA plans "don't have that option to switch to a lower-premium plan with a higher deductible," and added that some of those affected retired early and have to wait until they're 65 to enroll in Medicare. "These people are really in a difficult situation," she said.

Out-of-pocket maximums are also slated to increase, reaching $10,600 next year, roughly $1,200 more than in 2025.

"People look at $10,600 and panic," said Jennifer Chumbley Hogue, an insurance broker in Texas who sells ACA plans. "There's a big difference to the consumer between $9,000 and $10,000."

Jason Levitis, a senior fellow in the health policy division at the Urban Institute, said that increased ACA enrollment numbers could be a result of people swapping their higher-tier plans for less expensive ones with higher deductibles and later canceling.

"All of this stuff takes a while to diffuse through the system," he said.

(Swenson/Forster, Associated Press, 12/8; Abelson, New York Times, 12/8)

HHS officially repeals nursing home staffing mandate

HHS on Tuesday repealed a nursing home staffing mandate that was put into place in 2024 under the Biden administration.

The rule, which was finalized in April 2024, required nursing homes participating in federal programs like Medicare and Medicaid to meet a total nurse staffing standard of 3.48 hours per resident day, which had to include at least 0.55 hours per resident day of direct RN care and 2.45 hours per resident day of direct nurse aide care. Facilities were allowed to use any combination of nurse staff to account for the additional 0.48 hours per resident day needed to comply with the total nurse staffing standard.

In addition, the rule required nursing homes to have an RN on site 24 hours a day, seven days a week to provide skilled nursing care.

HHS expands use of AI

HHS on Thursday released an AI strategy that aims to expand the use of the technology across the department's workforce and modernize internal operations.

The strategy will be led by HHS acting chief artificial intelligence officer Clark Minor and will encompass five pillars:

• Governance and risk management
• Infrastructure and platform design
• Workforce development and burden reduction
• Research and reproducibility
• Modernization of care and public health delivery

The strategy invites all divisions of HHS to collaborate on building a robust, department-wide AI infrastructure, streamlining workflows, and improving cybersecurity. HHS said the strategy represents a first step aimed at improving internal operations and the federal use of AI, and that the strategy will guide future collaborations with private-sector partners to develop solutions maximizing AI's potential.

In addition, FDA unveiled an agentic AI program that employees can choose to use for complicated tasks like meeting management, premarket reviews, post-market surveillance, and inspections.

"We are diligently expanding our use of AI to put the best possible tools in the hands of our reviewers, scientists and investigators," said FDA Commissioner Marty Makary. "There has never been a better moment in agency history to modernize with tools that can radically improve our ability to accelerate more cures and meaningful treatments."

(Diaz, Becker's Health IT, 12/4; Incorvaia, Fierce Healthcare, 12/1)