On February 11, 2026, the Trump administration published the proposed 2027 Notice of Benefit and Payment Parameters, the annual rule governing coverage under the Affordable Care Act (ACA). Writing in their personal capacities along with colleagues at the Georgetown University Center for Health Insurance Reforms and the Brown University School of Public Health’s Center for Advancing Health Policy through Research, Levitis and O’Brien provide legal and policy analysis of the proposal, focusing on concerns about the rule’s effects on consumers, the analysis included with the rule, and the legality of proposals.
The comment explains that key provisions of the rule would make ACA health insurance more expensive, harder to get, harder to keep, and harder to use. The rule would reduce Marketplace enrollment by millions of people each year. Those who remain enrolled would face narrower benefits, more paperwork, and higher premiums as new administrative burdens disproportionately drive out healthier consumers. As a result, the rule would significantly weaken the coverage safety net that millions of Americans rely on and further strain a health care system that is already struggling to respond to last year's reconciliation bill, the expiration of the enhanced premium tax credits, and previous Trump administration rulemaking.
In addition, CMS’s analysis of the effects of the rule has serious shortcomings. It includes implausible estimates, omits crucial explanation of its assumptions and methods, and fails to disclose information crucial to understanding or justifying the rule, including information that CMS has access to. It purports to justify several proposals with concerns about improper enrollment driven by fraudulent broker activity, but it fails to explain how these concerns would be addressed by the rule’s proposals, many of which impose new burdens on consumers rather than addressing broker malfeasance. As a result, the analysis fails to provide either a reasonable basis for the rule or a meaningful opportunity to comment.
Finally, the rule includes numerous provisions that are contrary to the statute and to prior judicial decisions.
