Trump’s Health Care Proposal: Promised Consumer Protections or New Enrollment Challenges? – Insights from KFF Health News

The Trump administration recently proposed significant changes to the Affordable Care Act (ACA). Officials claim these changes aim to reduce fraud in the program. However, many experts warn that these changes may make it more difficult for consumers to obtain coverage, potentially leading to fewer people enrolling.

About 24 million Americans signed up for ACA plans for 2025, thanks to previous support measures under the Biden administration. These included increased premium subsidies and year-round enrollment opportunities for low-income individuals. However, last year saw a surge in fraudulent enrollment, with 274,000 complaints focused on rogue insurance agents.

The Trump administration stated that the new rules are necessary to ensure that people are not enrolled in plans without their knowledge. They also aim to stabilize insurance markets and ensure taxpayer funds are used appropriately.

Despite this, experts believe the new rules will create additional paperwork that could deter enrollment, especially among low-income consumers. Adding more eligibility checks could complicate access to coverage, according to Sabrina Corlette from Georgetown University’s Center on Health Insurance Reforms.

Under the proposed changes, consumers may need to submit more documentation to prove their eligibility for special enrollment periods and premium subsidies. The annual enrollment period would also be shortened by a month. Furthermore, these changes would limit coverage options for “Dreamers,” young immigrants who arrived in the U.S. unlawfully as children, and could remove continuous enrollment opportunities for very low-income individuals.

People who are automatically re-enrolled in zero-premium plans may now be required to pay a small fee each month until they confirm or update their information. Some consumers, especially gig workers, would need to provide estimates of their incomes for the coming year, adding to the administrative burden.

The Biden administration previously took steps to reduce fraud by requiring three-way calls among insurance brokers, clients, and the federal marketplace for certain sign-ups. Some of the new Trump administration measures, such as notifying consumers about unexpected enrollments through billing, could help highlight potential issues.

However, experts like Cynthia Cox from KFF believe the increased requirements could reduce overall enrollment, making it challenging for eligible individuals to prove their claims. The open enrollment period will now end on December 15, earlier than it has in the past, in hopes of preventing people from waiting until they are sick to sign up.

Additionally, the Trump proposal could reverse current policies allowing Dreamers to access ACA subsidies and exclude gender-affirming care from essential health benefits, which may lead to higher out-of-pocket costs for individuals requiring such services.

The proposed changes are now open for public comment, meaning they may still be revised before becoming final. Experts recognize that some of the new policies might increase enrollment difficulties for low-income individuals. However, the administration believes that preventing fraudulent enrollments justifies these challenges.

Discussions around unauthorized enrollment have gained attention, with some lawmakers and conservative groups citing fraud as a significant concern. There are calls for a reassessment of how enrollment periods and subsidies might affect the integrity of the ACA exchanges.

In summary, as the Trump administration moves forward with these proposals, the impact on health coverage access remains to be seen. The potential for reduced enrollment and increased challenges for consumers provides a complex picture of the future of the ACA.

Source link