The Trump administration has unveiled its first major changes to the Affordable Care Act (ACA), aiming to combat fraud within the program. While officials believe these steps are necessary, experts warn that they may make it tougher for people to sign up for health coverage, which could lead to fewer enrollments.
Currently, around 24 million Americans are enrolled in ACA insurance plans, often referred to as Obamacare. The Biden administration had previously boosted enrollment by increasing subsidies for low-income individuals, making some plans cost nothing monthly. They also allowed very low-income applicants to enroll at any time of the year, not just during a specific enrollment period. However, last year saw a rise in fraudulent enrollments, leading to concerns and complaints from consumers.
In their announcement, Trump officials stated that the new regulations are designed to protect individuals from being signed up for plans without their knowledge and to ensure that government funds are used correctly.
Experts have raised concerns that these new rules will add extra paperwork and requirements, which could deter people from signing up. Sabrina Corlette, a professor and co-director at Georgetown University, noted that in the effort to eliminate fraud, the administration might inadvertently penalize consumers, especially those with low incomes who need more straightforward access to coverage.
One proposed change includes requiring consumers to provide more documentation to prove they qualify for special enrollment periods or premium subsidies. The annual enrollment period would also be shortened by a month. Additionally, it would limit certain immigrants, known as “Dreamers,” from obtaining benefits—reflecting complications surrounding immigration issues in the healthcare system.
The program would also introduce new verification requirements for people who experience significant life changes, such as income shifts or job loss. They would need to provide proof during enrollment to confirm their eligibility. Furthermore, those automatically re-enrolled in no-cost plans would face small monthly fees until they verify their information.
The proposal suggests that health insurance marketplaces should collect more data from self-employed individuals or gig workers who might not have previous tax returns for income verification.
Last year, the Biden administration attempted to address enrollment fraud by requiring joint calls between brokers, their clients, and the federal marketplace when certain enrollments occurred. Some of the Trump administration’s new proposals might actually help identify when consumers have been unknowingly enrolled, such as requiring bills to be sent to those on low-cost plans.
However, the added complexities could make it difficult for many to receive the care they need. Experts worry that while these new rules aim to protect consumers from fraud, they might make it harder for legitimate applicants to navigate the system. For instance, demonstrating expected changes in income could be challenging for some individuals.
The proposed open enrollment period would now end a month earlier, on December 15, to prevent people from waiting until they need healthcare to sign up. This change aims to keep premium costs from rising too quickly.
In addition to controlling access, the proposal seeks to reverse recent policies that allowed Dreamers to access subsidized ACA coverage and exclude certain types of gender-affirming care from the essential health benefits that all plans are required to cover. This could lead to higher out-of-pocket costs for those requiring such services.
These proposals will enter a public comment phase, and modifications may occur based on feedback. There is uncertainty regarding when these changes will take effect, as it remains to be seen how much will apply in 2025 versus 2026.
While some lawmakers stress the need to address fraud in the ACA exchanges, others caution against enacting measures that could hinder access for eligible individuals. The debate continues around how best to balance program integrity with accessibility for all consumers.
Check out this related article: Trump’s Health Care Proposal: Promised Consumer Protections or New Enrollment Challenges? – Insights from KFF Health News
Source linkHealth Care, Health Insurance, Medicaid, Medicare, Research
