The Trump administration has proposed significant changes to the Affordable Care Act (ACA), aiming to tackle fraud in the program. Officials announced these changes on Monday, highlighting that they could make it more difficult for consumers to enroll in health coverage. This could lead to a decrease in the number of people signing up for insurance.
The announcement followed the accidental release of a draft press release. Currently, around 24 million Americans are enrolled in ACA plans, commonly known as Obamacare, for 2025. The Biden administration had previously boosted enrollment by increasing subsidies for low-income individuals, making some plans available at no monthly cost. They also allowed very low-income individuals to enroll year-round, rather than waiting for the annual enrollment period.
However, last year saw a rise in fraudulent enrollments, with approximately 274,000 complaints reported to the Centers for Medicare & Medicaid Services. These complaints largely involved rogue insurance agents and other dishonest practices. In response, the Trump administration stated that the new regulations would protect consumers from being enrolled without their knowledge and ensure that financial assistance is directed to those who truly need it.
Experts have expressed concern that these changes may create new hurdles for consumers, particularly those with low incomes. The proposed rules would require individuals 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, ending on December 15.
One significant change is the elimination of year-round enrollment for very low-income individuals. Now, those who want to enroll after life changes, such as a job loss or divorce, would need to provide evidence of their situation. Auto-reenrolled individuals in zero-premium plans would also face small monthly charges until they confirm or update their information.
The proposal also affects social issues, reversing a Biden-era policy that allowed “Dreamers”—young immigrants brought to the U.S. illegally as children—to qualify for ACA coverage. This change is already facing legal challenges from several states. Furthermore, the new rules would exclude gender-affirming care from the essential health benefits that all insurance plans must cover, potentially increasing out-of-pocket costs for those seeking such services.
While some aspects of the proposal may help identify consumers who have been unknowingly enrolled, the additional paperwork and eligibility requirements could discourage many from signing up. Experts warn that these changes could lower enrollment rates, particularly among those who may struggle to provide the necessary documentation.
The proposed regulations are now open for public comment and may be revised before they take effect. Experts are uncertain about how much of the proposal will be implemented in 2025 versus 2026. The administration believes that enhancing program integrity and reducing improper enrollments is more important than the potential negative impact on access to coverage.