WASHINGTON — President Donald Trump’s administration is proposing a docket of changes to enrollment in the Affordable Care Act, looking to clamp down on some policies aimed at boosting accessibility from former President Joe Biden’s time in office. It comes after the health care overhaul, known colloquially as "Obamacare," became a major topic on the campaign trail in 2024. 

What You Need To Know

  • President Donald Trump’s administration is proposing a docket of changes to enrollment in the Affordable Care Act, including shortening the annual open enrollment period by a month, closing the window on Dec. 15 instead, as well as ending coverage eligibility for DACA recipients known as “dreamers"
  • The administration is also aiming to limit coverage of gender-transition care by adding “sex-trait modification” to a list of services not considered essential health benefits, in what could be seen as part of its broader agenda on the topic after Trump signed an order recognizing only two sexes
  • Meanwhile, to specifically take on what the administration called a "dramatic uptick” in reports of people enrolled in the Affordable Care Act without their knowledge, it is looking to add a requirement that enrolled individuals pay a $5 monthly premium if they do not confirm or update their eligibility determination
  • In a release on the proposal from the Centers for Medicare & Medicaid Services, or CMS, the administration said the goal of the changes is to address improper enrollments in marketplace coverage and protect taxpayer dollars

Among the top modifications being pursued by the administration through a proposed rule released Monday is a shortening of the annual open enrollment period by a month, closing the window on Dec. 15 instead, as well as ending coverage eligibility for recipients of the Deferred Action for Childhood Arrivals program, known as “Dreamers." 

The Biden-era rule to expand access to the ACA to "Dreamers" was expected to apply to 147,000 immigrants but was already temporarily blocked by a judge in 19 states. 

The administration is also aiming to limit coverage of gender-transition care by adding “sex-trait modification” to a list of services not considered essential health benefits, in what could be seen as part of its broader agenda on the topic after Trump signed an order recognizing only two sexes.

Meanwhile, to specifically take on what the administration called a “dramatic uptick” in reports of people enrolled in the Affordable Care Act without their knowledge, it is looking to add a requirement that enrolled individuals pay a $5 monthly premium if they do not confirm or update their eligibility determination.

Other proposed changes include ending a monthly special enrollment period for those with household incomes below 150% of the federal poverty level and beefing up requirements to verify eligibility. 

In a release on the proposal from the Centers for Medicare & Medicaid Services, or CMS, the administration said the goal of the changes is to address improper enrollments in marketplace coverage and protect taxpayer dollars. The administration estimates its alterations would reduce federal spending on premium tax credits by $11 billion to $14 billion by 2027. 

The health care legislation passed under former President Barack Obama and once referred to by Biden, then vice president, as a “big f****** deal” on a hot mic, saw record enrollment under the previous administration. 

Republican efforts to repeal the sweeping health care overhaul under Trump during his first term in office fell short in Congress and the GOP’s crusade against it largely quieted in the years since. But the fight reawakened on the campaign trail last year, leading Trump to pledge to only attempt to get rid of it again if he can secure a better and less expensive plan. The newly reignited fight also led to a memorable debate line in which Trump said he has the “concepts of a plan” to replace "Obamacare."