On May 15, 2026, the Centers for Medicare & Medicaid Services released its annual final rule governing the Affordable Care Act Marketplaces and insurance reforms. The 2027 Notice of Benefit & Payment Parameters (NBPP) final rule implements certain provisions of H.R.1, changes or rolls back current policies, and introduces new changes. This analysis summarizes the NBPP and highlights implications for state-based Marketplaces and insurance regulators.