People in 2017 protest another attempt at taking health coverage away from millions of Americans at a time in which Donald Trump is president. (“2017.02.25 Rally in Support of Affordable Care Act #ACA Washington, DC USA 01250” by Ted Eytan / Flickr / CC BY-SA 2.0 license)

By Sunita Sohrabji, American Community Media

A proposed rule issued by the Centers for Medicare and Medicaid Services would potentially strip healthcare coverage for millions via the Affordable Care Act, and also make DACA recipients ineligible for coverage.

The “2025 Marketplace Integrity and Affordability Proposed Rule” is undergoing a public comment period, which ends at 11:59 p.m. EST on April 11. As of the afternoon of April 11, more than 22,000 comments had been entered.

Critically, the rule would also end “sex trait modification services” as an essential health benefit covered by ACA plans. Over 7,000 public comments entered in the Federal Register opposed this portion of the rule, with many noting transgender care is a “lifesaving tool.”

Open Enrollment

The rule would also add a $5 monthly surcharge for automatic reenrollment. Critics say this adds an extra level of bureaucracy that could confuse many and lead to disenrollment. Open enrollment time would be cut. Currently, open enrollment runs from Nov. 1 to Jan. 15. Under the proposed rule, that period would be cut by one month. CMS said in a press statement that it hopes to streamline the process for ACA enrollment.

Earlier this year, the Trump administration slashed the budget of the Navigator’s Program — which helped people enroll in ACA plans — from $100 million to just $10 million.

More than 45 million people are currently enrolled in ACA plans. Healthcare advocates predict huge drop-offs in ACA enrollment this fall if the proposed rule is implemented. “We’ve made so much progress in healthcare coverage as a nation. But we’re about to see that progress undone,” said Anthony Wright, executive director of Families USA, at an April 9 press conference.

President Donald Trump learned from his first term in office that the ACA is unlikely to be repealed, as it carries bipartisan support from constituents, said Wright. “So, instead of trying to repeal the ACA, Trump is dismantling it piece by piece.”

DACA Recipients

”The administration is sending a message to all immigrants: that they should not feel comfortable accessing health care,” said Ben D’Avanzo, senior strategist for health advocacy at the National Immigration Law Center. He explained that the proposed rule would amend the definition of lawfully present residents to exclude DACA recipients, also known as Dreamers. ACA coverage is only available to lawful permanent residents.

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D’Avanzo noted that the ACA has strong privacy protections which prevent the sharing of information with other government agencies, but added that immigrants — both legal and undocumented — might be concerned about the safety of their information, and sharing data that could affect their immigration status.

On Nov. 1, 2024, the Biden administration entered a new rule allowing DACA recipients to gain access to health care via the ACA. The proposed CMS rule threatens to undo the previous administration’s action, potentially stripping coverage for over 530,000 DACA recipients. Over 6,200 comments were entered into the Federal Register about DACA, the majority opposing excluding DACA recipients from ACA coverage.

Sabotaging Healthcare

Kristin McGuire, executive director of Young Invincibles, noted that young adults are among the largest populations without healthcare coverage. The ACA allows them to remain on their parents’ plan until they turn 26. But part-time jobs or gig work may not provide health insurance coverage, and wages may not be sufficient to cover even low-cost plans.

Post-pandemic, young adults have become the largest users of mental healthcare services, said McGuire, but barriers in the proposed rule would prevent them from getting the care they need.

”It has been the goal of this administration to sabotage healthcare,” she stated.

”The proposed rule would raise healthcare premiums by hundreds of dollars and raise out of pocket costs,” said Wright. “This attack on the ACA will cause millions of people to become uninsured, to become sicker, and die younger,” he said. “This is a huge step backwards.”