One year after H.R. 1’s enactment, advocates point to rising premiums, new Medicaid paperwork requirements, and coverage losses across Georgia
ATLANTA, Ga. (July 2, 2026): One year after H.R. 1 became federal law on July 4, 2025, more than 500,000 Georgians have dropped their marketplace health insurance coverage due, in part, to rising premiums. Newly released guidance from the Centers for Medicare & Medicaid Services (CMS) goes further than what is written in H.R. 1 in some cases, and makes accessing high-quality, affordable health care even more of a challenge for everyday Georgians.
Health advocates say the combined effects of marketplace subsidy changes, new administrative requirements, and future federal policy changes have significant implications for both Georgia families, health care providers, and communities statewide.
After Congress declined to extend enhanced premium tax credits under H.R. 1, which priced working-class Georgians out of marketplace coverage, the federal government has finalized a rule for the 2027 marketplace that will increase the paperwork needed for people to enroll in plans and receive financial help, permit unlimited annual out-of-pocket maximums for certain marketplace health plans, and make it more difficult to find in-network care.
Regarding Medicaid, a newly released CMS rule, which is intended to guide states like Georgia in their implementation of H.R. 1, will continue to leave low-income families without access to affordable care. By sharply restricting exemptions to Medicaid work reporting requirements, such as who is considered “medically frail,” and forcing severely ill individuals to navigate complex paperwork systems to keep their coverage, the new federal guidance will only perpetuate existing barriers and Georgia’s health care crisis. Georgia’s Pathways to Coverage program is a cautionary tale of what is to come for other states when the H.R. 1 Medicaid work requirement begins in January 2027: bureaucratic hurdles and suppressed enrollment for individuals with low incomes and high administrative costs covered by taxpayers.