Fixing Insurance Gaps:

Key Research Findings:

• Health Plan Growth: The number of people with healthcare coverage through the ACA marketplace health  exchange plans grew by 79% since 2021.

• Cost-Shifting to Patients: Since 2021, Affordable Care Act exchange plans have shifted 36% more prescription drug costs onto enrollees, driving average annual out-of-pocket spending up by ~$150 (from $412.64 to $560.75).

• $2,000 Rx Cap = High Taxpayer Value, Low Health Plan Risk: Only 5% of ACA enrollees spend over $2,000 annually on prescriptions.

The Bottom Line:

Congress should set a $2,000 Rx out-of-pocket cap in health exchange plans. This would protect patients, preserve plan design flexibility, and deliver greater value to taxpayers, all while having a minimal impact on premiums.