March 10, 2025 - Modern Healthcare
The Trump administration is proposing to limit the time frame for people to enroll in health insurance through Affordable Care Act exchanges, according to materials reviewed by Bloomberg News, potentially decreasing the number of people in these types of plans.
The annual deadline for people to enroll in health insurance plans is currently Jan. 15, but the Trump administration is proposing regulations that would shorten the enrollment window by a month, to close on Dec. 15 instead. The Centers for Medicare and Medicaid Services, which oversees the insurance marketplaces, will also propose canceling a monthly opportunity for people with incomes below 150% of the federal poverty line to enroll.
Related: Underinsured patients at risk if ACA subsidies lapse
The changes are an early glimpse into how President Donald Trump plans to alter the ACA, also known as Obamacare. During the 2024 campaign in a debate with Democratic nominee Kamala Harris, Trump said he had “concepts of a plan” to replace the ACA, but did not provide details. The law, a signature achievement of Barack Obama, has survived past legislative and legal assaults from Republicans.
The ACA currently provides coverage to some 45 million Americans either through the individual health plan marketplace or expanded Medicaid coverage. It’s become a major source of revenue for some health insurers, including Centene Corp. and Oscar Health Inc.
The number of people getting coverage on the ACA marketplaces dipped during Trump’s first term as president, as the administration pulled back some on subsidies and tried to repeal the law. But enrollment surged after Congress and former President Joe Biden expanded tax credits to lower costs, often making coverage available for little or no monthly premium.
Wall Street analysts have flagged the risks that companies selling ACA plans face from tighter enrollment rules. “We continue to believe the attrition of unauthorized enrollments poses a material threat” to 2025 profit margins, analysts from Jefferies wrote in February.
A record 24 million people chose plans on the ACA marketplaces during the most recent open enrollment period, according to CMS. That’s double the number of people enrolled at the start of Biden’s presidency.
The Trump administration said that the proposed change of Dec. 15 as the end of the enrollment window will encourage people to stay covered all year long instead of waiting until they are sick to apply.
Concerns about fraud have dogged the program. The agency has received tens of thousands of complaints about people being signed up for coverage or switched into different plans without their knowledge.
CMS changed the enrollment system in an attempt to crack down on unauthorized sign-ups. Conservative groups, including the Paragon Health Institute run by former Trump White House official Brian Blase, have raised concerns that people are being fraudulently enrolled in subsidized health insurance plans with free premiums.
To address those concerns, the Trump administration plans to reduce subsidies by $5 per month until enrollees confirm information about their income, requiring them to actively make a payment. The nominal change is meant to ensure people are aware of their coverage.
The move to ensure plan enrollees qualify for subsidies comes amid a larger push by the Trump administration to cut fraud across the federal government. CMS estimated the regulations collectively could save between $11 billion and $14 billion in subsidy dollars in 2027.
The regulations would also prohibit people who receive benefits through the Deferred Action for Childhood Arrivals program from enrolling in federally subsidized marketplace plans. A federal judge had already blocked that Biden administration policy from going into effect in some states.
The rule would also prohibit insurance plans on the exchanges from providing coverage of gender-affirming care as an essential health benefit.
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