Trump, RFK Jr. & Dr. Oz do their best to put lipstick on their pig

You may have seen this jaw-dropping nonsense yesterday, but if you didn't, here it is again:

Reporter: Unless ACA subsidies are extended, the average plan will increase by somewhere around 115%

(CMS Director) Dr. Oz: Where'd you get that number?

Reporter: The Kaiser Family Foundation

Dr. Oz: They retracted that. Here's the truth. The average American who's on ACA is gonna pay $13 more than this year. That's not a big issue.

(sigh) where to begin...

Well, for starters, no, KFF (formerly the Kaiser Family Foundation) has not "retracted" their 115% increase estimate (actually 114%). I wrote about it when they published that study last month, and the link to the analysis is still prominently displayed on their home page.

So, right out of the gate, Dr. Oz is flat-out lying.

Beyond that, this classic from The Onion about a decade ago comes to mind:

Company’s HR Manager Really Pushing Infinite-Deductible Health Care Plan

During a meeting with new hires Wednesday to discuss employee benefits, Radian Analytics human resources manager Ellen Schultz is said to have strongly pushed the company’s infinite-deductible health care option.

According to sources in attendance, Schultz described the low-premium, infinite-deductible plan as the simplest and most convenient choice available to employees, and said it works the same whether plan members need to visit their primary care physician, fill a prescription, or be admitted to a hospital, allowing them in each case to pay 100 percent of the incurred medical expenses.

Company officials explained that the health care option had been set up to address complaints employees had with previous plans, which often came with confusing paperwork and long wait times for reimbursement, problems that have disappeared now that the limitless deductibles have eliminated any need to even bother filing a claim.

“With our Infinity Plan, you’ll see only a very small amount deducted from each paycheck, and then all you’ll have to do is pay as you go for whatever health care you may need,” said Schultz, adding that employees who select the package will never need to worry about obtaining preauthorization for any procedure and can simply pay a bill in full upon receiving it from their medical provider.

Here's the Trump regime's Centers for Medicare & Medicaid Services (CMS) press release yesterday morning, as HealthCare.Gov launched window shopping for the upcoming 2026 ACA Open Enrollment Period:

The Health Insurance Marketplace® Open Enrollment Period for plan year 2026 begins on November 1, 2025, and runs until January 15, 2026. In plan year 2026, most enrollees on Healthcare.gov will have access to plans with premiums at or below $50 per month, after the application of premium tax credits. When compared to years prior to the COVID-19 pandemic, Marketplace enrollees this year will have access to, on average, plans with lower premiums after tax credits and more plan choices overall.

Premium Affordability: Eligible Healthcare.gov enrollees continue to have robust access to low premium plans after applying advance payments of the premium tax credit.

The claim that premiums will be "lower after tax credits" in 2026 is, of course, a complete crock of gaslighting bullshit, but there are some key caveats to keep an eye on here...most obviously "access to," "...for eligible enrollees" and "lowest-cost plan."

Similar to 2025, on average, tax credits are projected to cover 91% of the lowest cost plan premium in 2026 for eligible enrollees. This compares to 85% in the 2020 coverage year, which was the last coverage year not impacted by temporary COVID-19 pandemic policies.

The "lowest-cost plan" is a hell of an important asterisk. This refers to the least-expensive Bronze plan in most cases, possibly including a handful of Catastrophic plans in certain situations (Catastrophic plans aren't available in every state and are normally limited to enrollees under 30 years old, although the Trump regime has opened the floodgates on these as well to anyone not eligible for federal tax credits regardless of their age).

Setting Catastrophic plans aside for the moment, ACA policies are grouped into four different "Metal Levels" which indicate their general Actuarial Value (AV)...that is, the percentage of medical claims which the policies cover for their enrollees in aggregate.

Bronze plans have to cover roughly 60% of claims; Silver plans 70%, Gold 80% and Platinum 90%, give or take. With some exceptions, Bronze plans generally have lower premiums but higher deductibles while Platinum plans have the highest premiums but the lowest deductibles & other out-of-pocket costs.

Lower-income enrollees who choose Silver plans are also eligible for additional financial help (called Cost Sharing Reduction or CSR assistance) which boosts the AV rating for those plans much higher, to 94%, 87% or 73% AV depending on the enrollees income; the first two of these basically turn Silver into "Secret Platinum" plans, which I encourage all enrollees earning less than 200% of the Federal Poverty Level (FPL) to take advantage of.

The ACA was generally built around the hope that most enrollees would choose "Silver or Better" coverage, with Bronze plans ideally being reserved for folks who are healthy (and thus don't expect to rack up a lot of medical expenses) and/or wealthy (and therefore can afford to pay quite a bit out of pocket before hitting their deductible)...except of course that the vast majority of ACA enrollees aren't wealthy (if they were, they wouldn't need the subsidies!).

Over the past few years, largely thanks to the enhanced tax credits (with some credit also going to the adoption of maximized Silver Loading and Premium Alignment pricing strategies in a dozen or so states), the portion of ACA enrollees with GOLD-or-Better coverage has even increased a bit.

Unfortunately, between the expiration of those enhanced tax credits as well as other actions being taken by the Trump regime such as encouraging people to enroll in Catastrophic plans instead (which are generally in the same ballpark as low-end Bronze plans in terms of Actuarial Value), however, it's clear that things are about to head in the opposite direction: Less comprehensive coverage with sky-high deductibles & other out-of-pocket expenses. This is completely the wrong direction, and yet...

You can see it written all over this press release: They're pushing bare bones Bronze plans with ultra-high deductibles.

The average Marketplace premium after tax credits is projected to be $50 per month for the lowest cost plan in 2026 for eligible enrollees. While this represents a $13 increase from 2025, it remains $20 less expensive than the monthly premium after tax credits in 2020.

Again: The "$50/month" claim is limited to the lowest-cost plan for eligible enrollees...aka the least-expensive Bronze plan only, only if they're subsidized, and it's possible that this only includes the 30 states hosted on the federal exchange (I could be wrong about that part).

Even then, another way of phrasing "$50 is $13 more than it was last year" would be to say that even the dirt-cheapest Bronze plan will cost a whopping 35% more than it does today.

It's also important to keep in mind that the "$13 increase" is per month, which may not sound too bad until you remember that in some states we're talking about people who may earn as little as $1,310/month. When your income is that low, even a $13 hike could be the difference between paying your electric bill or buying groceries (especially with SNAP benefits about to be cut off...)

Put another way, imagine if your electric or water bill went up 35% overnight.

And as your income moves up the sliding scale, that $13/mo increase is gonna be a lot higher, I guarantee you.

In 2026, nearly 60% of eligible re-enrollees will have access to a plan in their chosen health plan category at or below $50 after tax credits. This compares to 83% of eligible enrollees in 2025 and 56% in 2020 with equivalent access.

There's that word "access" again. Access means that you're legally allowed to enroll in the plan; it doesn't mean you can afford to do so. I have "access" to buy a Ferrari; that doesn't mean I can afford to do so.

Beyond that, what the PR is saying is that even then, the number of enrollees who will have "access" to a plan in their "chosen category" (I'm not sure what that refers to) for less than $50/month will drop by 23 percentage points next year, which isn't something I'd be bragging about, but whatever.

Anyway, for more on this see Xpostfactoid's (Andrew Sprung's) post here.

Issuer Participation: For 2026 there are 183 Qualified Health Plan (QHP) issuers on HealthCare.gov. Out of the 30 states on HealthCare.gov for 2026, 19 have as many or more QHP issuers participating in 2026 than 2025.

This is another way of saying that 11 of the 30 states have fewer issuers participating next year which, again, isn't quite as positive a spin.

As for the remaining 21 states, I may be missing a few, but as far as I can tell:

• 2 states are gaining a carrier (Nevada & Washington)
• 11 states are holding steady (CO, CT, DC, ID, ME, MA, MN, NM, NY, RI & VT)
• 8 states are losing carriers (CA, GA, IL, KY, MA, NJ, PA & VA)

Overall that's 32 states holding steady or gaining and 19 states losing carriers nationally. Whether that's a big deal or not depends on your point of view, I suppose.

Enrollee Options: In 2026, HealthCare.gov enrollees continue to have access to a broad range of issuers. The average 2026 enrollee has between 6 and 7 QHP issuers available. In 2026, 95% of enrollees have access to three or more QHP issuers, compared to 96% in 2025 and 68% in 2020. In addition, less than 1% of 2026 enrollees have only one available QHP issuer, which is the lowest percentage in HealthCare.gov history.

This is actually...fine. I mean, it doesn't include the other 21 states which operate their own ACA exchanges, but I'm willing to accept that issuer participation is pretty much in line with last year.

By my count there are around 30 carriers pulling entirely out of various states (plus others partially pulling out of some counties but not others within a state). However, there are also 8 carriers newly entering states and others expanding their coverage into additional counties within a state...all of which is pretty typical.

Health Savings Account (HSA) Eligibility: President Trump's Working Families Tax Cuts Legislation expanded access to HSA-eligible plans that enable contributions to a consumer's HSA account by making all bronze and catastrophic Marketplace plans HSA-eligible plans. In 2026, this will make HSA-eligible plans available to every consumer in every county across the states that utilize HealthCare.gov. This expands access to HSA-eligible plans to at least 1.6 million additional HealthCare.gov consumers.

First of all, there is no such thing as the "Working Families Tax Cut Legislation" which was passed this year. It doesn't exist. This is the name that Trump and the GOP are desperately trying to rebrand the so-called "One Big Beautiful Bill" Act.

More to the point, while it's not necessarily a terrible thing to expand HSA eligibility, utilizing a HSA requires you to actually have several thousand dollars of liquid cash you can spare to put into the account.

Furthermore, you have to be able to leave it there to be used exclusively for medical expenses, since withdrawing it & using it for any other purpose (like, say, paying your rent, utility bills, for food so you don't starve to death, etc) will incur a 20% additional tax on top of the normal income tax which you have to pay for withdrawing it.

As everyone knows, low-income ACA enrollees are well known for having thousands of dollars in spare cash lying around. (That was sarcasm for those who didn't get enough sleep last night.)

In any event, I suppose if I was in charge of trying to put lipstick on this particular pig this is probably about as positive a press release as I could come up with.

At the very least I can point to this as the source for Dr. Oz's ludicrous claim that "the average American on the ACA is gonna pay $13 more than this year," which is coming as one hell of a surprise to the ~24 million people currently receiving notices that their premiums are gonna go up by hundreds or even thousands of dollars per month even as I'm typing this.