The Affordable Care Act Faces Challenges Amidst Enrollment Uncertainty
Enrollments under the Affordable Care Act (ACA) are facing obstacles this year, with new numbers projected to fall short of last year’s record figures by as much as a million. The Biden administration, as it transitions out, is grappling with disruptions in the program that could impact its future.
The uncertainty surrounding the health law’s fate under a second term for Donald Trump has added to the challenges. Additionally, the Biden administration has implemented stringent policies to combat fraudulent enrollments and is currently battling a lawsuit that seeks to prevent immigrants without legal residency from purchasing insurance through the ACA.
As of early December, the number of new and returning enrollees using healthcare.gov, the federal marketplace serving 31 states, is below last year’s figures. New enrollments stood at just over 730,000, compared to 1.5 million at the same time a year ago. To provide consumers in federal marketplace states more time to enroll, the Centers for Medicare & Medicaid Services extended the deadline to sign up for coverage starting January 1 to December 18 (with a January 15 deadline for coverage beginning February 1).
The Biden administration’s rule allowing enrollment in ACA coverage for individuals brought to the U.S. as children without immigration paperwork, known as “Dreamers,” is also in flux. A temporary stay was granted on December 16 by the U.S. Court of Appeals for the 8th Circuit regarding a previous ruling that favored 19 states seeking to block the directive. The case, Kansas v. the United States, could impact the enrollment and subsidies for ACA plans for Dreamers in those states.
The Biden administration argues that not granting a stay would disrupt open enrollment, leading to costs for the federal government in adjusting the marketplace and informing already enrolled individuals of plan cancellations. The original case was filed in August in the U.S. District Court for the District of North Dakota and is currently being heard by District Judge Daniel Traynor.
Despite the legal challenges, the federal government estimated that about 100,000 uninsured individuals out of half a million DACA recipients might enroll in 2025 coverage. However, only 2,700 have enrolled in the states involved in the lawsuit that utilize the federal marketplace.
The Biden administration’s rule, finalized in May, allows DACA recipients to be considered “lawfully present” for enrolling in ACA plans. The plaintiff states argue that the rule will impose administrative burdens and encourage unauthorized individuals to remain in the U.S. The states challenging the rule include Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Virginia.
