Posted on: August 7, 2025
Update on federal changes
Recent federal changes — including the Centers for Medicare & Medicaid Services' (CMS’) Marketplace Integrity Rule and , also referred to as the reconciliation bill — have major implications for the health care landscape in Washington state and across the nation.
Washington Healthplanfinder is Washington state’s official resource for signing up for qualified health plans (QHPs) and income-based Medicaid, and these federal changes affect how Washingtonians access health insurance and how the Exchange staff and partners support customers.
Regardless of what changes come from the federal level, the Exchange is committed to keeping as many people as possible covered and we are working on mitigation efforts of these harmful and restrictive policies.
Taken together, the cumulative effect of the changes to the Affordable Care Act (ACA) marketplaces would result in an estimated one-third to one-half of all current Washington Healthplanfinder QHP enrollees losing access to affordable health insurance. In addition, these policies are likely to destabilize the individual market and fellow state-based marketplaces — increasing premiums, reducing access to health insurance, increasing the number of uninsured and increasing the amount of uncompensated care provided by hospitals.
Overview: Upcoming changes
Many provisions make it harder to get and stay covered in state-based marketplaces and Medicaid, which will be implemented over time.
Over the next year, immigrant populations in Washington state will have eligibility for tax credits and Medicaid greatly reduced. The most immediate provision necessary to implement before open enrollment begins on Nov. 1 is to restrict federal tax credits for some immigrant populations.
"Marketplace Integrity” rule finalized
On June 20, 2025, the Centers for Medicare & Medicaid Services (CMS) finished a set of marketplace regulations restricting eligibility, reducing benefits and imposing new paperwork burdens on enrollment.
The final rule generally tracks what CMS proposed in March 2025, though with some changes, including sunsetting some provisions after 2026 and adding some flexibility for state-based marketplaces.
H.R. 1 – "Reconciliation bill" Medicaid and marketplace cuts
On July 4, 2025, President Trump signed the budget reconciliation bill with over $1 trillion in health care cuts by 2034. The marketplace cuts focus on legal immigrants and on imposing new barriers to enrollment.
The final bill includes many key provisions of the House version, though some pieces were removed.
Enhanced premium tax credits (ePTCs) scheduled to expire
Unless Congress acts, the PTC enhancements enacted in the 2021 American Rescue Plan Act and extended in the 2022 Inflation Reduction Act will expire at the end of 2025.
The expected expiration has already increased premiums in insurers’ 2026 rate filings.
Timeline of key marketplace changes
While some changes will affect customers immediately, many marketplace changes will be phased in over time and some changes don't apply in Washington state. The marketplace changes affecting Washington include:
- Eliminating automatic re-enrollment for people receiving premium tax credits by requiring reverification of tax credit eligibility before renewal.
- Eliminating provisional eligibility for premium tax credits while applicants are awaiting eligibility determinations.
- Removing the cap on the amount of tax credits that enrollees must repay to the government if their income changes during the year.
- Shortening the annual open enrollment period.
- Imposing new administrative burden on enrollees by adding additional income verification processes.
- Eliminating premium tax credits eligibility for most lawfully present immigrants.
- Not extending the marketplace enhanced premium tax credits.
What’s next?
The Exchange will continue to assess and keep our communities and partners informed of what federal changes mean for customers and our work. To learn more about these changes, review the Exchange’s . For more information about the specific effects on Medicaid, review .