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The Johns Hopkins Bloomberg School of Public Health held a media briefing on January 22, 2026, to discuss the future of health insurance coverage in the United States, with a focus on the Affordable Care Act (ACA), the expiration of COVID-era premium subsidies, and proposals to shift support toward health savings-style accounts. Topics discussed: Current state of ACA coverage and the expiration of COVID-era premium subsidies. How proposals to add money to health savings accounts compare with extending ACA subsidies. How “Health Freedom Accounts” or other HSA-focused proposals might work in practice and who would benefit. Impacts on people who do not rely on the ACA, including downstream impacts for those with employer-sponsored coverage, as well as Medicare and Medicaid. Insights from: Gerard Anderson, PhD, a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. His research focuses on health care spending, Medicare and Medicaid policy, and the management of chronic conditions. He is a member of the Maryland Prescription Drug Affordability Board. Elizabeth Fowler, PhD, a distinguished scholar in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Her research focuses on advancing innovative payment and care delivery models in Medicare and Medicaid to promote value-based care. Resources: How New Federal Legislation Will Affect Health Care Costs and Access for Americans https://publichealth.jhu.edu/2025/the... What’s Behind Rising Health Insurance Costs? https://publichealth.jhu.edu/2025/wha... The Potential Impacts of Cuts To Medicaid https://publichealth.jhu.edu/2025/the... Public Health On Call: The New Reality Facing Medicare, Medicaid, and the ACA https://podcast.publichealth.jhu.edu/... Timestamps 0:00 Introduction 01:20 How ACA plans differ from employer-sponsored plans 04:05 Why giving people money is not the same as having health insurance 06:36 What is causing health costs to rise 08:40 Individual Coverage Health Reimbursement Arrangement plans 09:34 Impact on hospitals 12:05 Should health insurers absorb costs from loss of ACA subsidies 13:34 Impact in rural areas 16:00 Advice for people who are uninsured 18:20 Effects on primary care 20:44 Impacts on getting preventative care 22:50 Advice for consumers where ACA enrollment is still active 26:55 How the U.S. health system compares to other countries 29:50 Closing remarks https://publichealth.jhu.edu / johnshopkinssph / johnshopkinssph / johnshopkinssph