Trump administration ditches Biden-era ACA flexibilities
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The Trump administration wants to roll back Biden-era changes to make signing up for Affordable Care Act marketplace plans easier for certain individuals and limit coverage of gender-affirming care.
Why it matters: The Centers for Medicare and Medicaid Services said in a notice Monday that the changes would reduce improper federal spending on premium tax credits for marketplace plans by $11 billion.
- Between 750,000 and 2 million people will lose their health insurance if all the changes are implemented as proposed, CMS wrote in the rule.
State of play: The first proposed CMS rule of President Trump's second term lays out a plan to end a monthly opportunity for low-income individuals to enroll in marketplace coverage, and shorten the annual open enrollment period by a month.
- "We believe several regulatory policies recently put in place to make it easier to enroll in subsidized coverage severely weakened program integrity and put consumers at risk from improper enrollment," CMS stated.
- Enrollment in ACA plans hit new record highs each year of the Biden administration. But reports of insurance brokers enrolling people in plans or changed their plan selection without consent have reportedly also increased in recent years.
CMS wants to let marketplace insurers require that enrollees pay their overdue premiums before new coverage kicks in.
- Regulators also propose requiring a $5 monthly premium for consumers who are automatically reenrolled in an ACA plan from one year to the next and would otherwise have fully subsidized coverage.
- This premium could be eliminated once the enrollee confirms their eligibility.
Zoom out: CMS also proposes stopping non-grandfathered individual and small group market plans from covering "sex-trait modification services" — a reference to gender-affirming care — as an essential health benefit that must be offered to all enrollees. The change would go into effect for 2026 coverage.
- Health plans could still voluntarily cover the services, and states could still choose to require that plans cover them, CMS said.
- The agency additionally plans to end ACA eligibility for undocumented immigrants brought to the U.S. as children, known as "dreamers."
What they're saying: "Joe Biden's reckless Obamacare expansion has not only been a disaster for taxpayers and a goldmine for fraudsters, but it has also failed to meaningfully increase health care access for Americans and has instead driven up the cost of coverage for all," House Ways and Means Chair Jason Smith (R-Mo.) said in a statement.
Go deeper: CMS last month announced it would significantly cut funding for ACA marketplace navigator services.
