The U.S. Capitol at night. Photo: iStock
Members of the U.S. House Appropriations Committee voted 34-28 Tuesday to support an appropriations bill that could take $1.9 billion in funding away from HealthCare.gov operations.
The bill would also take away any cash in the Patient-Centered Outcomes Research Trust Fund, which supports the Patient Centered Outcomes Research Institute. PCORI is supposed to use user fees from health coverage providers to fund studies comparing the effectiveness of different strategies for preventing and treating health problems. PCORI traditionally has had bipartisan support.
The bill would provide $3.7 billion in funding for the program management offices at the Centers for Medicare & Medicaid Services that run HealthCare.gov, Medicare and Medicaid. It would also provide $181 million in funding for the U.S. Department of Labor's Employee Benefits Security Administration.
These measures are part of the Labor, Health and Human Services, Education and Related Agencies Appropriations Act bill, which would provide $189 billion in funding for some federal government operations in the 2027 "fiscal year," which starts Oct. 1.
The bill's supporters now must try to win approval for the bill from the full House and from the Senate. The Senate typically eliminates the health program funding cuts included in House Appropriations bills.
What it means: HealthCare.gov supporters in the health insurance and benefits communities, and in the Senate will now have to spend time and energy to try to restore the HealthCare.gov and PCORI funding.
Few employers currently use coverage from the ACA exchange system, but some small employers without health benefits count on workers being able to buy their own individual coverage through the exchange system. The looming fight over restoration of the $1.9 billion in HealthCare.gov user fee funding and PCORI funding could have hard-to-predict positive or negative effects on employers' health benefits lobbying priorities.
The provisions: Republicans on the House Appropriations Committee included the proposed HealthCare.gov and PCORI funding changes in little-noticed sections tucked into a labor and health spending bill draft that the committee posted on the web last week.
HealthCare.gov is part of the Affordable Care Act health insurance exchange program. The ACA exchange program gives people a way to shop for individual and family major medical coverage online and use federal ACA premium tax credit subsidies to pay for the coverage.
The Centers for Medicare & Medicaid Services — an arm of the U.S. Department of Health and Human Services — oversees federal programs that affect commercial health insurance. CMS set up HealthCare.gov to provide ACA exchange services that are unwilling or unable to provide ACA exchange services. CMS charges the health insurers that sell their coverage through HealthCare.gov user fees.
CMS puts ACA exchange system management services under the same general budget heading that includes Medicare and Medicaid program management services.
The $3.7 billion in federal CMS program management funding included in the appropriations bill the House Appropriations Committee approved Tuesday is unchanged from the amount included in a Trump administration 2027 CMS funding request released in April. The amount is down about 10% from the $4.1 billion in CMS program management funding provided this year.
The committee was tougher on ACA exchange system managers than administration officials. In addition to providing $3.7 billion in CMS program management funding, the funding request would let ACA exchange system managers keep the $1.9 billion in cash reserves created using the HealthCare.gov plan issuer user fee revenue.
Rep. Steny Hoyer, D-Md., said during the House Appropriations Committee meeting on the labor and health bill that taking the cash away from ACA exchange managers is "squandering money we've already collected and making it harder for those without employer-provided coverage to get insurance they need".
Rep. Robert Aderholt, R-Ala., the bill's sponsor, said the $1.9 billion funding provision would simply take away the cash CMS has piled up.
"It is a commonsense accountability measure that prevents unnecessary accumulation of unused balances," Aderholt said.
Rep. Madeleine Dean, D-Pa., said at the House Appropriations Committee meeting that her understanding is that Republicans cut PCORI funding because they believe it funds research performed or funded by other federal agencies, including the Substance Abuse and Mental Health Services Administration, or SAMHSA, which faced pressure from the Trump administration's Department of Government Efficiency initiative.
"I guess my colleagues across the aisle forgot that DOGE fired the entire SAMHSA team and ripped hundreds more from other research-focused agencies," Dean said. "You cannot eliminate one source of expertise, weaken another, and then claim the work will somehow continue."
Employee Benefits Security Administration: The $181 million EBSA budget allocation included in the bill is the same as the allocation included in the Trump administration's 2027 DOL funding request.
The backdrop: The Trump administration recently approved a temporary ACA subsidy increase provided in response to the COVID-19 pandemic expire, and it has toughened ACA application verification rules.
Critics of the changes argue that the new rules are hurting enrollment and making getting coverage more difficult for people who are doing their best to follow the rules.
CMS officials say the new verification rules should make the ACA exchange system and premium tax credit system more honest and more stable.
The Trump administration has left funding for basic ACA exchange system administration functions mostly intact.
In addition to providing $3.7 billion in CMS program management funding for 2027, the CMS budget request shows that the agency expects HealthCare.gov to collect about $2.019 billion in user fee revenue in 2027, up from $2.044 billion in user fee revenue this year.
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