Recently, the Trump administration rolled back a rule that allowed young undocumented immigrants, known as Dreamers, to buy health insurance through Affordable Care Act (ACA) marketplaces. This change affects around 2,300 Dreamers in California who must now look for other health coverage or go uninsured.
Last year, under the Biden administration, Dreamers were permitted to sign up for health insurance after a change in the rules regarding who is considered “lawfully present.” This change gave DACA recipients access to coverage through state and federal marketplaces. However, two months after the Trump administration announced its reversal, the new policy took effect.
The federal Centers for Medicare and Medicaid Services (CMS), which oversees these marketplaces, stated the shift aims to improve healthcare affordability and access. But many experts argue that cutting coverage for young, healthy individuals could actually have the opposite effect. Arturo Vargas Bustamante, a public health professor at UCLA, explained that when fewer young people enroll, the overall insurance risk pool worsens. This can lead to higher costs for everyone, particularly older or sicker individuals who depend on insurance.
Jessica Altman, executive director at Covered California, expressed disappointment at the decision. She highlighted that it is unfair to hardworking individuals who believed they would have health coverage. Without such options, Dreamers could face tough choices. They might seek coverage through an employer or apply for Medi-Cal, but many freelancers may find themselves falling into a coverage gap where they earn too much for state aid but not enough to afford private insurance.
A recent study estimated that expanding coverage to DACA recipients could cost the federal government between $240 and $300 million annually. However, this expense is often overshadowed by the potential increases in premiums that everyone might face as a result of fewer young, healthy people in the insurance pool.
The legal landscape has also changed. Just last summer, 19 Republican attorneys general filed lawsuits to challenge the Biden administration’s plans. A federal judge in North Dakota ruled against the expansion, restricting marketplace access for DACA recipients in those states. This recent shift indicates that the impact could extend beyond California as more immigrant groups may soon face similar challenges. Starting in 2027, new federal regulations could limit marketplace assistance for several groups, including refugees and asylees, making it even harder for them to secure affordable coverage.
As discussions continue, the broader implications for healthcare access underscore the importance of considering how policy changes can affect vulnerable communities. The struggle for coverage remains a pressing issue, highlighting the ongoing debate around immigration and healthcare access in America.
