Updated 28 Nov 2025 
5 Minute Read 
President Barack Obama conceived the landmark health care reform known as Obamacare (Affordable Care Act) in 2010. The reform was enacted to provide affordable health care coverage, regardless of income and pre-existing conditions, and make healthcare more accessible.
Despite its success in decreasing the number of uninsured Americans by 20 million, the Trump administration spent much of the four-year tenure phasing out Obamacare by scaling-back federal investment and giving states more authority to run individual health insurance markets.
The Biden administration built significantly on the Affordable Care Act (ACA), leading to record enrollment and key consumer protections. However, as of 2026, the future of ACA affordability is highly uncertain due to the scheduled expiration of the enhanced premium tax credits (PTCs).
The health policy agenda over the last few years resulted in landmark changes, including the No Surprises Act and Medicare drug price negotiation. This post looks at these major reforms and addresses the critical financial risk facing millions of Americans due to the expiring ACA subsidies.
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His plan, called Bidencare, would fill in some of the ACA gaps and seek to cover millions of uninsured Americans. Specifically, he has pledged to give Americans more options, reducing costs, and make health insurance less complicated.
This post will look at the ACA’s proposed expansion and how it differs from Obamacare.
Creating a Public Health Insurance Option
The Public Health Insurance Option: Although proposed early in the administration, the public health insurance option was not enacted by Congress and remains a theoretical goal. The ACA Marketplace continues to operate through private insurers and state-level public programs (Medicaid/BHP).
The plan would be sold on the health insurance marketplaces, where millions already buy plans.
The idea is to increase the number of options available and lower the coverage costs among private insurers. The public option would also help low-income Americans ( living in a state opposed to Obamacare) find coverage.
Expansion of Eligibility
The most critical factor for 2026 is the scheduled expiration of the enhanced premium tax credits (PTCs).
- Return of the Subsidy Cliff: Subsidies are reverting to the pre-2021 rules, meaning the eligibility cap of $400 of the Federal Poverty Level (FPL) returns. Households above this income will lose all financial assistance.
- Cost Shock: The cap on premiums has increased significantly, and KFF estimates that subsidized enrollees will see their net monthly premium payments more than double $114 on average if the subsidies expire.
Stop Surprise Billing
This key reform was signed into law and took effect in January 2022. It bans balance billing for out-of-network emergency services and scheduled out-of-network services received at an in-network facility (like getting an out-of-network anesthesiologist at an in-network hospital). Patients are now only responsible for their in-network cost-sharing (copay/deductible) in these situations.
Price Limits for Drugs With No Competition
Without competition, it is especially challenging to keep the costs of new specialized drugs down. The administration successfully achieved drug price reform through the Inflation Reduction Act (IRA). This law authorizes Medicare to negotiate prices for a set number of high-cost drugs. The first negotiated prices for 10 major Medicare Part D drugs will take effect on January 1, 2026.
The board will recommend a reasonable price based on other countries’ prices or based on an evaluation.
Consumers Can Buy Prescription Drugs from Abroad
While the goal remains, the federal government has not implemented a wide-scale program to allow consumers to import drugs from abroad.
The expectation is this will drive down the cost of prescription drugs in the U.S. – something that has seen significant increases in the past decade.
When Can We Expect Changes to Be Made?
The reforms listed (No Surprises Act, IRA drug negotiation) are already law. The most urgent changes affecting your wallet in 2026 are the scheduled subsidy expirations. The fate of the enhanced premium tax credits now rests entirely with Congress to extend them before the end of 2025.
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