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This brief presents an analysis of targeted reforms to the Affordable Care Act (ACA). Taken together, the two policies analyzed here would lower federal health spending while improving insurance and medical care affordability for people faced with the full cost of nongroup insurance coverage. The first policy would either introduce a public insurance option offering ACA compliant coverage in the nongroup market or cap private nongroup insurers’ provider payment rates at levels based on those used in the Medicare program. The second policy would extend the ACA’s premium tax credits to eligible people with incomes above 400 percent of the federal poverty level; today, no one with income above this level is eligible for those credits.