The Trump administration recently finalized a major regulation governing the Affordable Care Act’s marketplaces, and community health plans are raising concerns about the impact the changes could have on consumers.
Heather Foster, vice president for marketplace policy at the Association for Community Affiliated Plans (ACAP), told Fierce Healthcare in an interview that one of the biggest challenges for the group’s members is just the timing of the rule.
The proposal was first issued in February and finalized last Friday. Foster said that means plans are adapting to the regulation in the midst of building their 2027 bids. The rule is usually issued earlier and finalized at the beginning of the year to account for this timeline; for example, the 2026 Notice of Benefit and Payment Parameters (NBBP) was finalized in mid-January 2025.
“This is months later than usual, so everything is compressed,” Foster said, “and you add in more things they have to do in a shorter timeframe. It’s hard.”
Operating on a condensed timeline like this, she said, also forces plans to change their approach in other planning that starts later in the year.
ACAP CEO Margaret Murray said in a statement following the final rule that plans operating on a condensed timeline or with just a proposed rule to work off of could also lead to downstream effects for consumers, as plans make decisions with incomplete information.
“Plans need time to operationalize policy changes in ways that protect consumers and preserve market stability,” Murray said. “Releasing the NBPP in the middle of the bid cycle is not a sustainable practice.”
In addition, the organization expressed concern about the impact of expansions for both non-network and catastrophic plans. In the rule, the Centers for Medicare & Medicaid Services establishes a framework for non-network plans that will go into effect in 2028.
And while that does give insurers time to adapt, Murray said that these plans do have the potential to “undermine the basic premise of Marketplace plans—that they provide access to care at an affordable, predictable cost.”
These plans lack traditional negotiated provider networks and instead often lean on a reference pricing model to pay for patient care. Foster said that the design takes a significant amount of work, as plans typically do, and instead places that on the consumer.
While they may be attracted to the potential for lower premiums and upfront costs, they’ll also have to invest time in diving fully into how their plan works, what the costs may be for specific services, and how much they could be billed for the care they need, she said.
“There’s both an administrative burden for the consumer—God forbid they’re sick and they don’t have the capacity to do that—but then there’s also a huge financial risk to them,” she said. “What happens if the care that they need far outweighs what will be covered?”
Another issue to consider, she said, is that these plans would be competing directly with coverage that does have a traditional network on an even playing field, even though the consumer experience would be significantly different if they made the switch.
In a similar vein, the NBPP would allow individuals to enroll in catastrophic plans for multiple years without the need for annual verification. These plans also generally carry lower premiums, but that’s in exchange for a higher deductible or out-of-pocket costs.
Murray said in the statement that the move “bodes poorly for market stability and erodes consumer protections.”
“Healthier enrollees drawn out of the regular Marketplace miss out on the comprehensive coverage with premium tax credits to make them more affordable,” she said. “Consumers may well put off needed care because they are forced to choose between seeing a doctor to check on an unexplained lump or putting gas in their car.”
“And when care gets delayed, everyone pays the price,” Murray said.
Foster said that expanding these plans could affect the risk pools in multiple ways. Pulling healthier individuals out of the regular risk pool through catastrophic plans would lead to a sicker mix across most medical tiers.
CMS also asked questions about potentially combining the risk pools, and Foster said that would likely nullify the premium benefits of the catastrophic plans, as premium costs would be based on the combined benchmarks.
“I think no matter which direction it goes, it runs the risk of having some unintended consequences,” she said.
The rule also comes at a time of notable turmoil for the exchanges following the expiration of post-COVID tax credits that surged enrollment, as well as significant program integrity measures. Both factors played a major role in rising premiums for 2026, which is leading many individuals to exit the market.
As plenty of questions remain around the final NBPP rule, it adds to the feeling of uncertainty, Foster said.
“I think this rule introduces even more uncertainty during a time of market uncertainty,” she said. “There’s already a lot of change [and] uncertainty, and we just don’t know what the impact of many of these more novel proposals will be.”
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