The Trump administration has announced it is taking action to combat the “troubling amount of improper enrollments” in Affordable Care Act health coverage.
Why It Matters
The ACA, signed into law by President Barack Obama in 2010, expands health insurance coverage, improves healthcare quality, and reduces healthcare costs. Some 24 million Americans signed up for insurance plans sold under the ACA, often referred to as Obamacare, for 2025.
What To Know
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to “address the troubling amount of improper enrollments impacting Affordable Care Act (ACA) Health Insurance Marketplaces across the country.”
According to CMS, enhanced premium subsidies—which helps lower monthly insurance premiums—introduced under the Biden administration in 2021 in response to the coronavirus pandemic, have contributed to a rise in improper enrollments. Citing a report from the Paragon Health Institute, the CMS estimates that in 2023, some 5 million people were enrolled in subsidized plans without proper eligibility, costing the federal government approximately $20 billion.
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The agency also highlighted an increase in data discrepancies in marketplace applications in recent years. In 2022, there were 6.3 million applications with mismatched information compared to federal databases—2.6 million more than in 2020. CMS argues that addressing these issues through its proposed reforms could lead to federal savings of $11 billion to $14 billion by 2027.
Another change under the proposed rule includes eliminate the year-round opportunity for a special enrollment period for people with very low incomes—at or below 150 percent of the federal poverty level. The agency said this provision has enabled people to delay enrollment until they become ill, rather than encouraging “continuous enrollment” that “fosters prevention and better health outcomes.”
The rule would make it so that enrollees would need to provide more information regarding their eligibility for special enrollment periods and premium subsidies.
In addition to changes targeting marketplace enrollment, the proposed rule would also redefine certain health coverage policies. These include excluding “sex-trait modification,” or transgender care, from the list of essential health benefits starting in 2026, and a reversal of previous policies that expanded ACA coverage access for those protected under the Deferred Action for Childhood Arrivals (DACA) program.
What People Are Saying
The CMS is a press release issued on March 10: “CMS’ 2025 Marketplace Integrity and Affordability Proposed Rule includes proposals that take critical and necessary steps to protect people from being enrolled in Marketplace coverage without their knowledge or consent, promote stable and affordable health insurance markets, and ensure taxpayer dollars fund financial assistance only for the people the ACA set out to support.”
Sabrina Corlette, a research professor and the co-director of the Center on Health Insurance Reforms at Georgetown University, told KFF Health: “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.”
What Happens Next
The measures now face a public comment period and potential revision before being finalized.
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