The Trump administration released its first significant set of proposed changes to the Affordable Care Act (ACA) on Monday, March 10. Federal officials claim that the aim is to combat fraud in the program. However, experts argue that these changes will make it harder for individuals to enroll, ultimately leading to many consumers not seeking coverage.
Around 24 million Americans enrolled in health plans for 2025 through the ACA marketplace, also known as Obamacare. The Biden administration saw record levels of enrollment after increasing subsidies to pay premiums for many low-income individuals, reducing some plans’ monthly costs to as low as $0. It also made it easier for individuals with very low incomes to enroll at any time of the year, rather than waiting for the fall enrollment period.
However, fraudulent enrollments affected the program last year, with the Centers for Medicare and Medicaid Services receiving around 274,000 consumer complaints by August, mostly related to dishonest insurance agents and other unethical actors.
The Trump administration stated in a press release on Monday that the new regulations include critical steps to protect individuals from being enrolled in marketplace coverage without their knowledge or consent, promote stable and affordable health insurance markets, and ensure that taxpayer money funds financial assistance only for those supported by the ACA.
Experts in policy argue that these changes will impose new paperwork burdens that are likely to hinder enrollment. Sabrina Corlette, a professor of research and co-director of the Center on Health Insurance Reforms at Georgetown University, stated that these changes penalize consumers, particularly those with low incomes, with more onerous requirements and limitations on their access to coverage.
Among the new requirements, consumers would have to provide more information demonstrating their eligibility for special enrollment periods and qualifying for subsidies at the time of enrollment. The regulation would also shorten the annual enrollment period by a month and touch on social issues, limiting the eligibility of Dreamers based on proposals like the DREAM Act.
The proposal would eliminate the opportunity for individuals with very low incomes to enroll at any time of the year. It would also establish new requirements for remaining special enrollment periods, allowing individuals to enroll after experiencing significant life events, such as income changes, loss of job-based coverage, divorce, marriage, or relocation. They would now have to provide more evidence of their eligibility when applying in these special situations.
Individuals automatically re-enrolling in zero-premium plans during the regular enrollment period would be charged a small monthly fee until they confirm or update their information. The proposal also requires ACA marketplaces to seek additional data from consumers, including self-employed or gig workers who estimate their income for the following year but do not have tax return data filed with the IRS for previous years.
Last year, the Biden administration implemented changes to reduce fraudulent enrollments, including requiring three-way calls between insurance brokers, their clients, and the federal insurance marketplace, healthcare.gov, when certain enrollments or coverage changes were made.
While some of the proposed changes by the Trump administration could help alert certain consumers of being unknowingly enrolled in an ACA plan, the additional paperwork and eligibility requirements are likely to impact enrollment negatively. Cynthia Cox, Vice President and Director of ACA Program at KFF, noted that these changes could deter some low-income eligible individuals from enrolling.
The annual open enrollment period would end on December 15, a month earlier than this year, to prevent individuals from waiting until they are sick to enroll, a measure that helps control premium increases. The Trump proposal also affects social issues, reversing the Biden administration’s policy allowing Dreamers to qualify for subsidized ACA coverage, a decision currently facing legal challenges.
The proposal also excludes gender affirmation care from the “essential health benefits” that all plans must cover. This provision could lead to higher out-of-pocket expenses for individuals requiring gender-affirming services, as they may need to seek plans offering this coverage separately or pay for the services out of pocket.
As the proposed rules now face a public comment period and possible revisions before being finalized, it is important to note that they will not take effect immediately. However, some legislators and conservative groups have expressed concerns about unauthorized enrollment and the role that ACA subsidies or enrollment periods could play in exacerbating this issue.
For instance, the Paragon Health Institute, a right-leaning organization, published a report in June calling for the reversal of the expanded special enrollment period for low-income individuals implemented by the Biden administration. Brian Blase, former health advisor during the Trump administration and president of the Paragon Health Institute, emphasized the need for a different approach to protect legitimate enrollees and taxpayers.
In conclusion, while the proposed changes aim to improve program integrity and reduce improper enrollments, they may also increase administrative burdens and dissuade some eligible low-income individuals from enrolling. It remains to be seen how these changes will be implemented and their impact on enrollment in the coming years.
