Proposed Changes Would End Coverage for DACA Recipients, Make Coverage More Expensive and Difficult to Find, and Impose Costs to States
Attorney General Charity Clark joined a multistate comment letter regarding a raft of proposed changes that would undermine the Affordable Care Act (ACA), making it more difficult and expensive for individuals to enroll in health coverage on federal and state exchanges, and also foreclosing DACA recipients to buy health insurance on the exchanges.
If allowed to take effect, the proposed ACA changes will cause between 750,000 and two million Americans to lose health insurance coverage in 2026 and will create significant health and economic damage to the states as more people are forced to go without health care, driving up costs for everyone.
In 2024, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) released a Final Rule increasing patient access to state and federal exchanges under the ACA. This rule allows DACA recipients, also known as Dreamers, who are allowed to live and work in this country pursuant to deferred action, to purchase affordable health insurance on ACA exchanges.
However, last month, the Trump Administration initiated the process of trying to undo this rule. If allowed to go into effect, the plan would remove access to insurance from DACA recipients, even if the middle of the year, when they are counting on this insurance for their medical care. That harms the States too: if these residents lose access to preventive medical care via their insurance, they may need to seek more expensive emergency room care, harming public health and economic well-being for communities across the State.
Other proposed changes are equally disturbing. For instance, one part of the rule would force all state ACA exchanges to shorten their open enrollment periods, instead of allowing them to run for longer periods.
Another part of the rule would allow health insurance plans to deny enrollment to anyone who once missed even a single payment for a health insurance premium, no matter how long ago the missed payment occurred. The rule does not require insurers to notify their consumers if they implement this policy—meaning consumers could be denied coverage without being aware that their denial is because they owe a past-due premium. In previous rulemaking, the federal government understood that nonpayment could be due to a variety of factors and that insurers currently have sufficient methods to collect past-due payments.
In addition, the rule would prohibit states from including coverage for gender-affirming care as an essential health benefit, representing a dangerous intrusion into the doctor-patient relationship. The Trump Administration claims, without evidence, that gender-affirming care is rarely covered in employer-based health plans. In fact, surveys indicate that coverage for these benefits has expanded significantly, with 72% of Fortune 500 companies offer gender-affirming care in 2024, up from 0% in 2002.
The comment letter is available to read here.
In addition to Attorney General Clark, the letter was signed by the Attorneys General of Arizona, California, Colorado, Connecticut, the District of Columbia, Delaware, Hawaii, Illinois, Maryland, Maine, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, Washington, and Wisconsin.
CONTACT: Amelia Vath, Outreach and Communications Coordinator, 802-828-3171