What Happened?

If you buy health insurance through an ACA marketplace, the Senate just let stand a rule that could cost you dental coverage and premium subsidies. The Senate voted 48-51 on Sept. 29 to block a challenge to a Trump administration rule that sets the payment, enrollment, and benefit standards for health insurance sold through the Affordable Care Act (ACA) marketplaces. That rule, issued by the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs government health insurance programs, took effect July 20 and now stays in place.

The rule makes several concrete changes to how ACA marketplace plans work, including eliminating the federal requirement that insurers offer standardized plan options, expanding access to lower-cost catastrophic coverage for some consumers, and prohibiting insurers from including routine adult dental services as an essential health benefit. These changes affect anyone who buys coverage through the federal or state ACA marketplaces, a pool that includes millions of Americans who do not get insurance through an employer.

Why Does it Matter to Me?

Routine adult dental coverage can no longer be counted as an essential health benefit, meaning insurers are not required to include it in marketplace plans. If your current plan includes dental care, that coverage could disappear when your plan renews.

The rule also adds new income and enrollment verification requirements, which could affect whether some consumers qualify for advance premium tax credits, the subsidies that lower monthly insurance costs for millions of Americans. Consumers who cannot meet the new verification steps could lose those subsidies, raising what they pay each month. It sets the fee that insurers pay to use the federal exchange platform at 1.9 percent of monthly premiums, a cost that can factor into what plans charge.

Both Sides, Now

Sen. Tammy Baldwin (D-WI) introduced the resolution to overturn the rule using the Congressional Review Act, a law that lets Congress cancel recently issued federal rules by a simple majority vote. All 45 Senate Democrats and both independents voted to move forward, joined by Sen. Susan Collins (R-ME), for a total of 48 votes in favor. The other 50 Republicans voted against proceeding, and Sen. Dan Sullivan (R-AK) did not vote.

CMS said the rule would strengthen program integrity, expand consumer choice and flexibility, and reduce regulatory burdens. Supporters of the resolution argued the rule weakens coverage protections for people who rely on marketplace plans. The resolution has 15 cosponsors, all Democrats or independents, and no Republican cosponsors. The party-line nature of the vote reflects a long-running disagreement over how tightly the federal government should regulate what marketplace plans must cover.

What Happens Next?

The resolution remains on the Senate Legislative Calendar as Calendar No. 456, but the failed vote leaves the CMS rule in force unless Congress acts again. For the rule to be nullified, both the Senate and the House would need to pass a Congressional Review Act resolution, and the resolution would have to be enacted.

An identical House resolution would also need to advance through that chamber. With Republicans controlling the Senate and opposing the challenge, another attempt faces the same math. Individual provisions of the rule apply on different schedules, so some changes to marketplace plans are still rolling out. Consumers shopping for 2027 coverage during the next open enrollment period will encounter a marketplace already shaped by the rule.

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