Enrollment First, Inc.

What’s Next in Health Coverage?

What’s Next in Health Coverage for Gig Workers and Contractors? 

At Enrollment First, we’re helping professionals across industries access the kind of benefits once reserved only for traditional employees. As the healthcare environment shifts, here’s how we see the landscape evolving — and what it means for you. 

Will subsidies remain strong enough to keep premiums affordable? 

That’s the million-dollar question. Under current law, enhanced Affordable Care Act (ACA) premium tax credits are set to expire at the end of 2025. Many analysts project a dramatic shock to consumers if that happens: 

  • Without renewed subsidies, net premiums (what individuals pay after credits) could rise by over 75% on average1. 
  • Even with subsidies in place, insurers are already proposing double-digit increases — the median premium hike for 2026 filings is about 18%1. 
  • The federal government is taking steps to implement a new CMS rule that aims to lower individual health insurance premiums by about 5%, on average, by tightening fraud and enrollment rules2. 
  • On the flip side, if Congress delays or fails to act, those gains could be limited. Some analysts suggest only a 2.4% premium reduction in 2026 from policy changes, because insurers already priced in uncertainty3. 

Bottom line: Subsidies remain the primary lever for affordability. How Congress or future administrators act will largely determine whether premiums stay within reach or become prohibitively expensive. 

How will reforms address gaps for gig workers and 1099 contractors? 

Gig workers and independent contractors often fall between the cracks in traditional employer-based systems, but reforms and policy proposals are emerging to close those gaps: 

  • One promising strategy is Association Health Plans (AHPs). Association health plans allow their members to access group health plans.  
  • Individual Coverage Health Reimbursement Arrangements (ICHRAs). These let businesses (or organizations) reimburse individuals for their marketplace premiums, broadening access to coverage outside classic group plans4. 
  • Flexible and portable benefit models are gaining momentum. Some states are already experimenting with portable benefits systems tailored for the gig economy. 
  • Reforming Health Savings Accounts (HSAs) to expand eligibility and contribution rules is also under discussion, enabling gig workers to better manage their own health costs6. 

These reforms won’t be automatic or uniform — adoption will depend heavily on state laws, federal regulation, and political will, but momentum is building. 

Could states gain more flexibility in shaping their markets? 

Yes — and perhaps more than you might expect: 

  • Recent proposals and reconciliation efforts have reduced state flexibility in key areas, such as regulating exchanges and local insurers7. 
  • At the same time, courts and policy debates are exploring how federal rules can allow state-specific innovations, like reimagined marketplaces, tailored benefit mandates, or dynamic subsidy formulas. 
  • Some states are already leading with consumer-friendly experiments — for instance, offering public options, reinsurance programs, or enhanced consumer protections that deviate from federal defaults. 
  • The tension is real: the more states innovate, the more pushback there tends to be around federal consistency and risk pools, but the next few years may see bold states showing what’s possible. 

Enrollment First is watching all this because it matters for how we design benefits access for freelancers, independent professionals, small business teams, and more. If you’re wrestling with how these changes could affect your plan options, your risk, or your budget — let’s talk. 

1: https://www.healthsystemtracker.org/brief/early-indications-of-the-impact-of-the-enhanced-premium-tax-credit-expiration-on-2026-marketplace-premiums/?utm_source=chatgpt.com 

2: https://www.cms.gov/newsroom/press-releases/cms-finalizes-major-rule-lower-individual-health-insurance-premiums-americans?utm_source=chatgpt.com 

3: https://www.fiercehealthcare.com/payers/delaying-aca-subsidy-legislation-past-sept-30-limits-next-years-premium-reductions-cbo?utm_source=chatgpt.com 

4: https://www.mercatus.org/research/policy-briefs/flexible-and-portable-benefits-independent-workers-federal-policy-guide?utm_source=chatgpt.com 

5: https://www.aspeninstitute.org/blog-posts/the-gig-economys-next-act-balancing-flexibility-and-security-for-workers/?utm_source=chatgpt.com 

6: https://hbhi.jhu.edu/publications/reforming-hsas-expand-gig-workers-access-affordable-health-care?utm_source=chatgpt.com 

7: https://chir.georgetown.edu/the-reconciliation-bill-eliminates-long-standing-state-flexibility-to-operate-marketplaces-and-regulate-private-health-insurance/?utm_source=chatgpt.com