The Trump administration recently unveiled proposed changes to the Affordable Care Act (ACA) aimed at combating fraud within the program. These new regulations, while intended to protect consumers from unauthorized enrollment and promote stable insurance markets, may inadvertently hinder enrollment for many.
The changes come in response to a surge in fraudulent enrollment in the ACA marketplace, with over 274,000 consumer complaints reported through August of last year. The proposed regulations include requirements for consumers to provide more documentation to prove their eligibility for special enrollment periods and premium subsidies. Additionally, the annual enrollment period would be shortened by a month, and certain groups, such as Dreamers, may face limitations on their eligibility for coverage.
One of the key provisions of the proposed changes is the elimination of year-round special enrollment periods for individuals with very low incomes. Instead, consumers would need to provide evidence of their eligibility when applying under specific circumstances, such as income changes or loss of job-based coverage. Furthermore, individuals auto-reenrolled in zero-premium plans would now be required to pay a small monthly fee until their information is verified.
The proposal also introduces new requirements for the ACA marketplaces to collect additional data from self-employed individuals or gig workers who estimate their income for the upcoming year. These measures aim to enhance program integrity and reduce improper enrollments, but they may pose challenges for some individuals in documenting their eligibility.
While the Trump administration’s proposed changes could help identify unknowingly enrolled individuals and deter fraudulent activity, they may also deter eligible low-income individuals from enrolling due to increased administrative burdens. Lawmakers and conservative groups have raised concerns about unauthorized enrollment and the impact of ACA subsidies on the issue of fraud.
As the proposed rule undergoes a public comment period and potential revision, it remains uncertain when the changes will take effect. The Biden administration’s efforts to expand special enrollment periods and coverage for certain groups have faced criticism from some who argue for a more stringent approach to protecting legitimate enrollees and taxpayers.
In conclusion, the proposed changes to the ACA represent a complex balancing act between preventing fraud and maintaining access to affordable healthcare for all Americans. The final regulations will need to carefully consider the potential impact on enrollment and ensure that the integrity of the program is upheld.
