Between the ACA subsidy cliff, rising 2026 employer health costs, newly indexed ESRP penalties, a GLP-1–driven pharmacy spend squeeze, and a growing price-transparency crackdown, the ground is shifting fast for brokers. Below are five developments to watch, what changed, how each one hits your book.

ACA Subsidy Cliff: Extension Push Heats Up

House GOP bill introduced last week would extend the enhanced ACA premium tax credits for one year, while Senate Democrats are pressing insurers to warn members about potential premium spikes if subsidies lapse. The politics are fluid, but both chambers are now openly engaging the issue [Politico] [Axios]

Why it matters for brokers:

• Build two scenarios for Jan 1 renewals: with vs without the enhanced credits.
• Expect client questions on 2026 premiums and subsidy eligibility.
• Prep outreach lists for members most exposed to subsidy changes.

2026 Employer Health Costs: Another Big Jump

Health costs are set to climb again in 2026. Employer forecasts point to 6–7% growth even after plan changes and close to ~9% without them. The push comes from specialty pharmacy (GLP-1s included), higher utilization, and provider wage inflation. For brokers, that means earlier budget talks and a tighter playbook on plan design, funding, and vendor levers. [Reuters]

Why it matters for brokers:

• Socialize plan-design trade-offs early (networks, steerage, site-of-care).
• Pair cost control with behavioral health access and COE programs to avoid false savings.
• Use trend data to justify multi-year funding strategies (level-funded, captives, stop-loss optimizations).

Employer Mandate (ESRP) Penalties: 2026 Amounts Updated

As shared in the newsletter last month, the OBBBA is causing some big industry shake ups. The IRS indexing lifts the Affordable Care Act §4980H employer shared-responsibility penalties for 2026 to $3,340 (a-penalty) and $5,010 (b-penalty) per affected employee. [Thomson Reuters Tax]

Why it matters for brokers:

• Re-run pay-or-play models for ALEs; small affordability misses get more expensive.
• Tighten measurement & offers (95% rule, dependents) and validate affordability safe harbors.
• Align with payroll/HRIS on Form 1095-C data quality to avoid Letter 226-J surprises.

GLP-1 Whiplash + Pharmacy Trend: Cost Pressures Are Real

GLP-1s are now the top pressure point in pharmacy trend. Employers report pharmacy at roughly 24% of total spend, with Rx costs projected to rise 11–12% into 2026. At the same time, coverage is tightening—TRICARE For Life ended coverage for obesity-only GLP-1s as of Aug 31. This is a signal that more plans may add guardrails like prior auth, step therapy, or outcomes programs. Expect continued volatility in access, cost, and member expectations.[Business Group on Health ]

Why it matters for brokers:

• Prepare GLP-1 coverage grids (obesity vs diabetes indications, PA rules)
• Negotiate transparent PBM contracts (guaranteed net cost, audit rights, utilization levers)
• Educate members on clinical eligibility + alternatives (i.e weight-management programs, Centers of Excellence) to manage demand responsibly.

Price Transparency Crackdown: Fines & New Mandates Proposed

A bipartisan Senate bill—the Patients Deserve Price Tags Act—would codify hospital price transparency rules, raise non-compliance penalties, expand requirements to other sites of care, and push payers to offer real-time cost tools for members. [Health Leaders Media]

Why it matters for brokers:

• More usable price data supports steerage strategies (HPCNs, COEs, ambulatory migration)
• Real-time OOP tools improve member decision-making and your client reporting.
• Watch for plan & PBM disclosure duties that may add to employer fiduciary work.

The post 5 End of Summer Broker Alerts: Subsidies, GLP-1s, Penalties & More appeared first on Sana Benefits.

A key component, Title II: The American Healthcare Choices Act of 2025, embeds deregulation and tax changes directly affecting benefits markets—elevating broker roles from compliance facilitators to strategic advisors in a competitive landscape. [Congress]

This blog breaks down what’s changing, compares the “before” vs. “after,” and highlights what it means for your clients and commissions.

The ACA and CAA era was about compliance. This next chapter? It’s all about open competition. And as a broker, your role is about to evolve—fast.

Medicaid Changes

The bill’s Medicaid overhaul introduces stricter eligibility rules, including work and income verification requirements. While this shrinks public coverage rolls, it also creates a surge of newly uninsured individuals—many of whom will turn to brokers for help finding new plans.

Before:
Brokers rarely engaged with Medicaid enrollees, as most were covered automatically or through government outreach.

After:
New rules require verification of income and work status, pushing ~7.8 million people off Medicaid by 2034 [KFF]. Many will seek individual ACA coverage, employer-sponsored plans, or short-term options—markets where brokers are essential.

This is a massive opportunity for brokers:

• Displaced enrollees will need help evaluating ACA, ICHRA, short-term, or employer-sponsored options.
  
• State-to-state variations mean local expertise will matter more than ever.
  
• Brokers who proactively build Medicaid offboarding funnels and outreach campaigns can grow their book significantly—especially in rural and low-income markets.

Why Brokers should care:

Medicaid may not have been your market before. But starting now, it absolutely is.

ACA Marketplace Shifts

The ACA isn’t going away, but it’s changing fast. From disappearing subsidies to shortened enrollment windows and heightened fraud enforcement, brokers who rely on marketplace sales must prepare for leaner margins, faster deadlines, and higher compliance standards.

Before:
ACA plans offered enhanced subsidies, broad access, and a long open enrollment season through January 15.

After:

• Subsidies disappear end of 2025, with premiums expected to rise 15–20% [Vox]
  
• Open enrollment ends December 15, cutting the window by 30 days [Enroll Insurance]
  
• Brokers face audits: CMS already suspended 850+ agents for improper enrollments [Washington Post]
  

Why brokers should care:
Expect a surge in client questions, tighter eligibility rules, and an uptick in compliance headaches.

Employer-Sponsored Plans & Telehealth

Employers offering high-deductible plans just got a win: telehealth pre-deductible coverage is now permanently allowed. This change makes HDHPs more flexible—and gives brokers new value to spotlight when designing or pitching group plans.

Before:
The IRS telehealth “safe harbor” for HDHPs had expired in 2024, limiting coverage flexibility.

After:
The bill makes the safe harbor permanent and retroactive to January 1, 2025 [Senior Market Sales].

Why brokers should care:

This opens the door for employers to offer first-dollar telehealth without jeopardizing HSA eligibility—an attractive benefit for cost-conscious groups.

Rural Hospital & Provider Landscape

Rural healthcare access has long been fragile. With new funding allocated to rural hospitals—but deep Medicaid cuts still on the table—the stability of networks in less populated areas remains uncertain. Brokers in these regions should stay alert to shifting coverage landscapes.

Before:
Rural providers were under threat from ongoing Medicaid underfunding and provider consolidation.

After:
A $50 billion Rural Hospital Fund aims to stabilize care access [Health Action Council]. But Medicaid cuts may still undermine rural coverage in the long term.

Why brokers should care:
Brokers in rural markets must stay in tune with network shifts, hospital partnerships, and potential plan exits.

Administrative & Compliance Burden

This bill doesn’t just reshape coverage—it increases scrutiny. With new verification rules and aggressive oversight, brokers now face a heightened risk of audits and suspensions. Operational discipline and documentation have never been more important.

Before:
Brokers dealt with income checks mainly on the ACA side. Medicaid enrollment was largely passive or state-managed.

After:
Both Medicaid and ACA now carry stricter verification requirements and heavy broker oversight. CMS is actively auditing agents and suspending licenses for noncompliance [Washington Post].

Why brokers should care:
Broker operations must modernize. Compliance systems, documentation protocols, and staff training are no longer optional.

Key Broker Takeaways:

These policy shifts aren’t abstract—they directly affect a broker’s book of business. Whether you sell individual ACA plans, worksite benefits, or group coverage, the One Big Beautiful Bill brings both risk and opportunity. This section breaks down the big takeaways—and what smart brokers should do next.

• ~7.8M clients leaving Medicaid will need new plans
  
• ACA premiums rise sharply post-2025
  
• Enrollment window tightens (Dec 15 deadline)
  
• CMS audits rising — documentation matters
  
• Telehealth safe harbor boosts HDHP flexibility
  
• Rural funding helps, but Medicaid gaps may widen

The post Broker Pivot: The “One Big Beautiful Bill” Era is here. appeared first on Sana Benefits.