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I can't say that I have your answers, but let me dreg up some memories of similar discussions.   First, the statement "A self-employed health insurance adjustment of $[______] from premiums paid  through an exchange is included as an adjustment to income but does not appear on these worksheets." appears at the bottom of form 7206, the Health Insurance Deduction. This was noted two or three years ago as an issue, and so far as I know, the adjustment to income still does not appear on any worksheets.   Next, if you look carefully at form 7206, and at the Self-Employed Health Insurance Deduction Worksheet—Schedule 1, Line 17 in the 1040 Instructions (on page 94), you will see that there is a peculiar relationship between medical insurance premiums, the deductible portion of SE taxes, and contributions to Self-Employed SEP, SIMPLE, and Qualified Plans.   Simply (?) put, on the worksheet for line 17 (Schedule 1) above, you take the (A) amount of premiums that you paid for health insurance established under your self-employed business (including for spouse and dependents under age 27), and then you look at the (B) net profit from your business less (the deductible portion of the SE taxes (line 15) and the contributions to the Self-Employed SEP, SIMPLE, and Qualified Plans (line 16)), and then your health insurance deduction is the lesser of either the amounts A or B.   (Note that each line is not so simple - see the notes for the worksheet above).   For self-employed health insurance plans that are from the Marketplace, I assume that the health insurance (A) paid is the actual amount minus any PTC, which, as you know, gets calculated in the return and which can change on a whim.   It's a lot easier to see this on the worksheet at the link above.   If you have enough fingers and toes and some imagination, you will see that there can be situations where when you increase your contributions to your self-employed retirement plans, you reduce your health insurance deduction. And when you consider that the amount of PTC can vary as you vary your income, the health insurance deduction can wander all over the place for no reason to easily recognize. I am guessing that this (the variability of the PTC amount as it affects the calculation on the worksheet or on the 7206) is the "A self-employed health insurance adjustment" referred to in the second paragraph.   Now ponder this, and see if it helps any.