On 10th March 2025, the Trump administration issued its first major proposed changes to the Affordable Care Act (ACA), intending to eliminate fraud from the health insurance program. “The strict regulatory changes to the documentation of the enrollment process would strictly reduce enrollment of customers,” said policy experts. His news article from The CEO Views has discussed the proposed changes to ACA and its pros and cons for enrolled persons.
Disorder in the Affordable Care Act
As per a report, around 24 million Americans signed up for ACA health insurance plans for 2025, popularly known as Obamacare. Record-breaking enrollment levels are observed after premium subsidies for many lower-income people, resulting in a reduced monthly cost of some plans to $0.
Also, there was no waiting period for the enrollment of many lower-income people, as they were allowed to enroll at any time of the year instead of a particular waiting period. However, despite such flexibility, the ACA program became a center of fraudulent enrollment last year., resulting in 274,000 consumer complaints throughout August. Rogue agents from healthcare and health insurance centres were identified to be the heads behind such conspiracies.
In response to this situation, The Trump administration stated in a statement on Monday that as per the new regulations, people will be protected from being enrolled in Marketplace coverage without their awareness or consent through critical steps. Administrators must promote stable and affordable health insurance markets and must ensure taxpayers fund financial assistance only to the ACA people they support.
Potential Consequences of the Proposed Changes
Sabrina Corlette, the co-director of the Center on Health Insurance Reforms and research professor at Georgetown University has said, “Under this banner of trying to crack down on the bad actions of some insurance brokers, they are penalizing consumers, particularly low-income consumers, with more burdensome requirements and more limits on their access to coverage.”
As per policy experts, these changes will undoubtedly impose new paperwork burdens to hamper enrollment.
What’s NEW???
Enrollment in ACA has come up with new provisions, making enrollment more strict under Trump’s administration. Below are some new requirements to enroll in ACA-
1) More Information on Eligibility
Consumers would have to provide more information on their eligibility for special enrollment and premium subsidies while enrolling.
2) Shortened Enrollment Period
The new ACA regulation would shorten the annual enrollment period by a month. It has also limited the eligibility for “Dreamers,” the illegal immigrants brought into America as children under the non-enforced DREAM Act.
3) Changes in Enrollment Period for Low-incomes
The new proposed ACA amendments would eliminate the year-round opportunity for a special enrollment period with very low incomes. However, it is also expected to set new requirements for the remaining special enrollment periods, allowing people to sign up after major life events, such as changes in income, losing job-based coverage, divorce, marriage, or others. People applying under those special situations would now have to prove their eligibility with proper evidence.
4)Monthy Payments for People Availing Zero-premium Plans
Another significant change in the enrollment of ACA under Trump’s authority has changed the scenario of healthcare in America. As per the proposal, people who would reenroll into zero-premium plans during the enrollment period would have to pay a small monthly payment until they confirm or update their information.
5) Additional Consumer Data
As per the newly proposed plan, the ACA marketplace would have to seek additional data from consumers, be self-employed or gig workers to estimate their income for the coming year, but do not have tax return data filed with the IRS for previous years.
6) Three-way-Calls
In order to reduce the fraudulent enrollment of the ACA health insurance, the Biden administration made changes like requiring three-way calls among insurance brokers, clients, and the federal insurance marketplace, healthcare.gov, during sign-ups or coverage changes.
Benefits of the Proposed Changes to ACA Enrollment
The changes proposed by Trump’s administration could prove to be beneficial for people who were fraudulently enrolled. Some customers on the least expensive plan will receive a small monthly premium bill, which could make them aware of their unknowing enrollment to an ACA plan. The additional paperwork and eligibility requirements will protect the enrollees who were deceitfully signed up or don’t know that they are still signed up.
Other Things We Need to Know About the Proposal
The proposal can be difficult for some people if they are not able to inform about an expected change in their income. Cynthia Cox, a Vice-President and the director of the program on the ACA at KFF has articulated, “They might have a legitimate claim but have a hard time demonstrating it.”
It has been informed that the annual open enrollment period would end on December 15, a month earlier than before. This has been done to prevent people from waiting to get enrolled until they fall sick and initiate slow premium growth. The proposal of Trump’s proposal on health insurance goes beyond healthcare and caters to social issues. It would reverse the Dreamers policy and gender-affirming care would not be considered a part of the essential health benefits that plans must cover.
